Healthcare Provider Details

I. General information

NPI: 1962749838
Provider Name (Legal Business Name): KINETIC ORTHOTICS & PROSTHETICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2013
Last Update Date: 03/30/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2571 PEMBROKE RD
GASTONIA NC
28054-4712
US

IV. Provider business mailing address

2571 PEMBROKE RD
GASTONIA NC
28054-4712
US

V. Phone/Fax

Practice location:
  • Phone: 704-691-7145
  • Fax: 704-691-7631
Mailing address:
  • Phone: 704-691-7145
  • Fax: 704-691-7631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateNC

VIII. Authorized Official

Name: ANNA KOURTNEY FOX
Title or Position: PARTNER
Credential:
Phone: 704-691-7145