Provider Demographics
NPI:1851684302
Name:KINS, KEONI MARK (DPT)
Entity Type:Individual
Prefix:MR
First Name:KEONI
Middle Name:MARK
Last Name:KINS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7125 GRAND MONTECITO PKWY
Mailing Address - Street 2:SUITE 120
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-0260
Mailing Address - Country:US
Mailing Address - Phone:702-515-1540
Mailing Address - Fax:
Practice Address - Street 1:7125 GRAND MONTECITO PKWY
Practice Address - Street 2:SUITE 120
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-0260
Practice Address - Country:US
Practice Address - Phone:702-515-1540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-17
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2448225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV109914Medicare PIN