Healthcare Provider Details

I. General information

NPI: 1528707726
Provider Name (Legal Business Name): KINETIC FLOW PHYSICAL THERAPY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2022
Last Update Date: 06/06/2022
Certification Date: 06/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11913 AVON WAY STE 4
LOS ANGELES CA
90066-9006
US

IV. Provider business mailing address

11913 AVON WAY STE 4
LOS ANGELES CA
90066
US

V. Phone/Fax

Practice location:
  • Phone: 270-320-4023
  • Fax:
Mailing address:
  • Phone: 270-320-4023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NEIL TAING
Title or Position: CEO
Credential:
Phone: 270-320-4023