Provider Demographics
NPI:1205883246
Name:KINETIC MUSCLES, INC.
Entity type:Organization
Organization Name:KINETIC MUSCLES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF SCIENCE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:BRYANT
Authorized Official - Last Name:KOENEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:480-557-0448
Mailing Address - Street 1:1800 W BROADWAY RD
Mailing Address - Street 2:SUITE #3
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-1023
Mailing Address - Country:US
Mailing Address - Phone:480-557-0448
Mailing Address - Fax:480-557-0449
Practice Address - Street 1:1800 W BROADWAY RD
Practice Address - Street 2:SUITE #3
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-1023
Practice Address - Country:US
Practice Address - Phone:480-557-0448
Practice Address - Fax:480-557-0449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ07659863-N332BC3200X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment