Provider Demographics
NPI:1760828131
Name:OMNI KINETICS
Entity Type:Organization
Organization Name:OMNI KINETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GRAHAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:POLAKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MS, ATC
Authorized Official - Phone:248-229-8628
Mailing Address - Street 1:3602 NORMANDY RD
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-1651
Mailing Address - Country:US
Mailing Address - Phone:248-229-8628
Mailing Address - Fax:
Practice Address - Street 1:8768 N TERRITORIAL RD
Practice Address - Street 2:C/O FOX HILLS
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-5022
Practice Address - Country:US
Practice Address - Phone:248-229-8628
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-13
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy