MEDICARE: KINETIX PHYSIOTHERAPY & PERFORMANCE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1407482805
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINETIX PHYSIOTHERAPY & PERFORMANCE, LLC

Provider Business Mailing Address
First Line	:	420 E CENTRAL AVE
Second Line	:
City	:	MOUNT HOLLY
State	:	NC
Zip	:	28120-2116
Country	:	US
Telephone Number	:	301-514-7426
Fax Number	:

Provider Business Practice Location Address
First Line	:	420 E CENTRAL AVE
Second Line	:
City	:	MOUNT HOLLY
State	:	NC
Zip	:	28120-2116
Country	:	US
Telephone Number	:	301-514-7426
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CHRISTOPHER LEWIS
Credential	:
Telephone Number	:	301-514-7426

Provider Enumeration Date	:	03/17/2020
Last Update Date	:	03/17/2020

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