Provider Demographics
NPI:1952378085
Name:KINETIC THERAPY SERVICES, A PHYSICAL THERAPY CORPORATION
Entity Type:Organization
Organization Name:KINETIC THERAPY SERVICES, A PHYSICAL THERAPY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DRAGOS
Authorized Official - Middle Name:ALEXANDRU
Authorized Official - Last Name:OPREA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-861-7214
Mailing Address - Street 1:10317 BIRCHDALE AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-2636
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10317 BIRCHDALE AVE
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-2636
Practice Address - Country:US
Practice Address - Phone:562-861-7214
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAWPT26688225100000X
CA225X00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19294Medicare ID - Type UnspecifiedPT GROUP NUMBER