1336376821 NPI number — KINEMATIC CONCEPTS PHYSICAL THERAPY & SPORTS REHAB

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336376821 NPI number — KINEMATIC CONCEPTS PHYSICAL THERAPY & SPORTS REHAB

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KINEMATIC CONCEPTS PHYSICAL THERAPY & SPORTS REHAB
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MOMENTUM PHYSICAL THERAPY & SPORTS REHAB
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336376821
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/27/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8627 CINNAMON CREEK DR
Provider Second Line Business Mailing Address:
SUITE 402
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78240-1480
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-695-2682
Provider Business Mailing Address Fax Number:
210-598-0432

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10555 CULEBRA RD
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78251-3666
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-888-6042
Provider Business Practice Location Address Fax Number:
210-888-6045
Provider Enumeration Date:
06/11/2009

Additional Information

Authorized Official

Authorized Official Last Name:
ELMS
Authorized Official First Name:
CHAD
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
210-372-9600

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  647890003 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0084HN . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com