Provider Demographics
NPI:1710490354
Name:KINESIST LLC
Entity Type:Organization
Organization Name:KINESIST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:MUTOKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-303-6276
Mailing Address - Street 1:12064 SPRITE LN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-6593
Mailing Address - Country:US
Mailing Address - Phone:321-303-6276
Mailing Address - Fax:
Practice Address - Street 1:12064 SPRITE LN
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832-6593
Practice Address - Country:US
Practice Address - Phone:321-303-6276
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT15208225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty