Provider Demographics
NPI:1891284618
Name:KNEETIX MOBILE PAIN THERAPY
Entity Type:Organization
Organization Name:KNEETIX MOBILE PAIN THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JEMILLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:434-420-0466
Mailing Address - Street 1:2732 ROODS CREEK RD BLDG 27
Mailing Address - Street 2:
Mailing Address - City:HANCOCK
Mailing Address - State:NY
Mailing Address - Zip Code:13783-1861
Mailing Address - Country:US
Mailing Address - Phone:434-420-0466
Mailing Address - Fax:
Practice Address - Street 1:2732 ROODS CREEK RD BLDG 27
Practice Address - Street 2:
Practice Address - City:HANCOCK
Practice Address - State:NY
Practice Address - Zip Code:13783-1861
Practice Address - Country:US
Practice Address - Phone:434-420-0466
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-07
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY268111261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care