Provider Demographics
NPI:1689216830
Name:KINETIC PHYSICAL THERAPY
Entity Type:Organization
Organization Name:KINETIC PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:TEMMEL
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:845-270-1468
Mailing Address - Street 1:3166 ARROYO VIS
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-7602
Mailing Address - Country:US
Mailing Address - Phone:845-270-1468
Mailing Address - Fax:
Practice Address - Street 1:3166 ARROYO VIS
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-7602
Practice Address - Country:US
Practice Address - Phone:845-270-1468
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-09
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy