Provider Demographics
NPI:1023430204
Name:KINESTHETIC PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:KINESTHETIC PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:NOEL
Authorized Official - Last Name:SIMS
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:678-516-0895
Mailing Address - Street 1:3850 CANTON RD
Mailing Address - Street 2:BUILDING 100/SUITE 1114
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-2608
Mailing Address - Country:US
Mailing Address - Phone:678-516-0895
Mailing Address - Fax:678-281-7658
Practice Address - Street 1:3850 CANTON RD
Practice Address - Street 2:BUILDING 100/SUITE 1114
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-2608
Practice Address - Country:US
Practice Address - Phone:678-516-0895
Practice Address - Fax:678-281-7658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-07
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT008203261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
202I656707OtherMEDICARE