Provider Demographics
NPI:1992186944
Name:KINETICS AND NEURO CONSULTANTS OF TEXAS, LLC
Entity Type:Organization
Organization Name:KINETICS AND NEURO CONSULTANTS OF TEXAS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAYA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-832-6972
Mailing Address - Street 1:810 HERITAGE PKWY S
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-5754
Mailing Address - Country:US
Mailing Address - Phone:817-832-6972
Mailing Address - Fax:
Practice Address - Street 1:810 HERITAGE PKWY S
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-5754
Practice Address - Country:US
Practice Address - Phone:817-832-6972
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-16
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty