Provider Demographics
NPI:1831250661
Name:KINETIC REHAB PLUS, INC.
Entity type:Organization
Organization Name:KINETIC REHAB PLUS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SURENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:KUMAR
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:313-274-1224
Mailing Address - Street 1:2421 MONROE ST
Mailing Address - Street 2:STE 104
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-3043
Mailing Address - Country:US
Mailing Address - Phone:313-274-1224
Mailing Address - Fax:313-274-1244
Practice Address - Street 1:2421 MONROE ST
Practice Address - Street 2:STE 104
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-3043
Practice Address - Country:US
Practice Address - Phone:313-274-1224
Practice Address - Fax:313-274-1244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P24810Medicare ID - Type UnspecifiedMEDICARE PART B PROVIDER
MIP24810002Medicare ID - Type UnspecifiedPHYSICAL THERAPY
MIP24810001Medicare ID - Type UnspecifiedOCCUPATIONAL THERAPY