1932449576 NPI number — KINEMATIC CONCEPTS PHYSICAL THERAPY & SPORTS REHAB, PLLC

Table of content: (NPI 1932449576)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932449576 NPI number — KINEMATIC CONCEPTS PHYSICAL THERAPY & SPORTS REHAB, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KINEMATIC CONCEPTS PHYSICAL THERAPY & SPORTS REHAB, PLLC
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:
6
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:
1932449576
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:
210-888-1279

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3456 HWY 16 SOUTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BANDERA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-796-3447
Provider Business Practice Location Address Fax Number:
830-796-3685
Provider Enumeration Date:
02/19/2013

Additional Information

Authorized Official

Authorized Official Last Name:
BRAME
Authorized Official First Name:
HEATHER
Authorized Official Middle Name:
DAWN
Authorized Official Title or Position:
CREDENTIALING SPECIALIST
Authorized Official Telephone Number:
210-372-0211

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  647890007 , 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)





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