Healthcare Provider Details

I. General information

NPI: 1679017842
Provider Name (Legal Business Name): KINNEY PHYSICAL THERAPY & WELLNESS,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2016
Last Update Date: 12/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2955 E HILLCREST DR #108
WESTLAKE VILLAGE CA
91362-3176
US

IV. Provider business mailing address

605 HAMPSHIRE RD #434
WESTLAKE VILLAGE CA
91361-2382
US

V. Phone/Fax

Practice location:
  • Phone: 805-494-3131
  • Fax:
Mailing address:
  • Phone: 805-444-9546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DANIEL KINNEY
Title or Position: OWNER
Credential: PT
Phone: 805-444-9546