1699154419 NPI number — KINNEY PHYSICAL THERAPY, LLC

Table of content: (NPI 1699154419)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699154419 NPI number — KINNEY PHYSICAL THERAPY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KINNEY PHYSICAL THERAPY, LLC
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:
Provider Other Organization Name Type Code:
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:
1699154419
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/14/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1221 S CLARKSON ST STE 311
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80210-1628
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
720-432-0155
Provider Business Mailing Address Fax Number:
720-634-0802

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1221 S CLARKSON ST
Provider Second Line Business Practice Location Address:
SUITE 311
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80210-1625
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
720-432-0155
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/26/2015

Additional Information

Authorized Official

Authorized Official Last Name:
KINNEY
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
PATRICK
Authorized Official Title or Position:
OWNER/PHYSICAL THERAPIST
Authorized Official Telephone Number:
720-432-0155

Provider Taxonomy Codes

  • Taxonomy code: 2251X0800X , with the licence number:  0012212 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com