Provider Demographics
NPI:1821397365
Name:KINETIC REHAB SOLUTIONS, LLC
Entity Type:Organization
Organization Name:KINETIC REHAB SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:VERNON
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L/MOT
Authorized Official - Phone:904-755-1311
Mailing Address - Street 1:12615 BRADY PLACE BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-2590
Mailing Address - Country:US
Mailing Address - Phone:904-755-1311
Mailing Address - Fax:904-239-5984
Practice Address - Street 1:12615 BRADY PLACE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-2590
Practice Address - Country:US
Practice Address - Phone:904-755-1311
Practice Address - Fax:904-239-5984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-23
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT12624225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty