Healthcare Provider Details

I. General information

NPI: 1053230045
Provider Name (Legal Business Name): KINETIQ SPINE & SPORT PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 PARK AVE
ARLINGTON MA
02476-4149
US

IV. Provider business mailing address

805 MASSACHUSETTS AVE
ARLINGTON MA
02476-4732
US

V. Phone/Fax

Practice location:
  • Phone: 617-826-9345
  • Fax:
Mailing address:
  • Phone: 617-826-9345
  • 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: MEGHAN MCCONVILLE MONTANO
Title or Position: OWNER
Credential: MSPT, OCS, CERT. MDT
Phone: 617-826-9345