Healthcare Provider Details

I. General information

NPI: 1205883246
Provider Name (Legal Business Name): KINETIC MUSCLES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 02/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 W BROADWAY RD SUITE #3
TEMPE AZ
85282-1023
US

IV. Provider business mailing address

1800 W BROADWAY RD SUITE #3
TEMPE AZ
85282-1023
US

V. Phone/Fax

Practice location:
  • Phone: 480-557-0448
  • Fax: 480-557-0449
Mailing address:
  • Phone: 480-557-0448
  • Fax: 480-557-0449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number07659863-N
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number07659863-N
License Number StateAZ

VIII. Authorized Official

Name: DR. JAMES BRYANT KOENEMAN
Title or Position: CHIEF SCIENCE OFFICER
Credential: PH.D.
Phone: 480-557-0448