Provider Demographics
NPI:1780123075
Name:KINETIC ORTHOPAEDIC PHYSICAL THERAPY, INC.
Entity type:Organization
Organization Name:KINETIC ORTHOPAEDIC PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:H
Authorized Official - Last Name:PAKOZDI
Authorized Official - Suffix:
Authorized Official - Credentials:PT, OCS
Authorized Official - Phone:310-312-5678
Mailing Address - Street 1:1950 SAWTELLE BLVD
Mailing Address - Street 2:SUITE 190
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-7014
Mailing Address - Country:US
Mailing Address - Phone:310-312-5678
Mailing Address - Fax:
Practice Address - Street 1:1950 SAWTELLE BLVD
Practice Address - Street 2:SUITE 190
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025
Practice Address - Country:US
Practice Address - Phone:310-312-5678
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-20
Last Update Date:2017-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT10216261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy