Healthcare Provider Details

I. General information

NPI: 1063733442
Provider Name (Legal Business Name): KINETIC PHYS THERAPY AND WELLNESS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2010
Last Update Date: 06/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 E ARLINGTON BLVD
GREENVILLE NC
27858-5870
US

IV. Provider business mailing address

1540 E ARLINGTON BLVD
GREENVILLE NC
27858-5870
US

V. Phone/Fax

Practice location:
  • Phone: 252-364-2806
  • Fax: 252-364-2863
Mailing address:
  • Phone: 252-364-2806
  • Fax: 252-364-2863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARLIE DAVID EDWARDS
Title or Position: PRESIDENT
Credential: PT, DPT
Phone: 252-902-7061