Healthcare Provider Details

I. General information

NPI: 1407704752
Provider Name (Legal Business Name): KINETIQ REHABILITATION, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 NE 2ND AVE APT 412
MIAMI FL
33132-2908
US

IV. Provider business mailing address

1489 W PALMETTO PARK RD STE 410-X
BOCA RATON FL
33486-3325
US

V. Phone/Fax

Practice location:
  • Phone: 954-609-0978
  • Fax:
Mailing address:
  • Phone: 305-306-7429
  • Fax: 305-489-7863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: NICOLAS TEJADA
Title or Position: FOUNDER/PRESIDENT
Credential: PT
Phone: 954-609-0978