Provider Demographics
NPI:1912186818
Name:K2 PHYSIATRY, PA
Entity Type:Organization
Organization Name:K2 PHYSIATRY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRSTEINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-297-2271
Mailing Address - Street 1:510 N ELAM AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27403-1150
Mailing Address - Country:US
Mailing Address - Phone:336-297-2271
Mailing Address - Fax:336-294-2282
Practice Address - Street 1:510 N ELAM AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-1150
Practice Address - Country:US
Practice Address - Phone:336-297-2271
Practice Address - Fax:336-294-2282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC34651208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty