Healthcare Provider Details

I. General information

NPI: 1902316508
Provider Name (Legal Business Name): KINETIC REHABILITATION CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2017
Last Update Date: 10/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13421 SW 51ST ST
MIAMI FL
33175-5213
US

IV. Provider business mailing address

13421 SW 51ST ST
MIAMI FL
33175-5213
US

V. Phone/Fax

Practice location:
  • Phone: 305-218-8380
  • Fax:
Mailing address:
  • Phone: 305-218-8380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License NumberPT28785
License Number StateFL

VIII. Authorized Official

Name: MR. ADRIAN GARCIAMOREIRA
Title or Position: PRESIDENT
Credential: RPT
Phone: 305-218-8380