Provider Demographics
NPI:1932449576
Name:KINEMATIC CONCEPTS PHYSICAL THERAPY & SPORTS REHAB, PLLC
Entity Type:Organization
Organization Name:KINEMATIC CONCEPTS PHYSICAL THERAPY & SPORTS REHAB, PLLC
Other - Org Name:MOMENTUM PHYSICAL THERAPY & SPORTS REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:BRAME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-372-0211
Mailing Address - Street 1:8627 CINNAMON CREEK DR
Mailing Address - Street 2:SUITE 402
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1480
Mailing Address - Country:US
Mailing Address - Phone:210-695-2682
Mailing Address - Fax:210-888-1279
Practice Address - Street 1:3456 HWY 16 SOUTH
Practice Address - Street 2:
Practice Address - City:BANDERA
Practice Address - State:TX
Practice Address - Zip Code:78003
Practice Address - Country:US
Practice Address - Phone:830-796-3447
Practice Address - Fax:830-796-3685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-19
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX647890007225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00612TMedicare UPIN