Provider Demographics
NPI:1720197775
Name:KINETIC REHABILITATION SERVICES
Entity Type:Organization
Organization Name:KINETIC REHABILITATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:STENKEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-340-2216
Mailing Address - Street 1:393 TOWNSHIP LINE RD
Mailing Address - Street 2:
Mailing Address - City:CHALFONT
Mailing Address - State:PA
Mailing Address - Zip Code:18914-1428
Mailing Address - Country:US
Mailing Address - Phone:215-340-2216
Mailing Address - Fax:
Practice Address - Street 1:920 TOWN CTR
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:PA
Practice Address - Zip Code:18901-5182
Practice Address - Country:US
Practice Address - Phone:215-340-2216
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA125085Medicare PIN