Healthcare Provider Details

I. General information

NPI: 1962503342
Provider Name (Legal Business Name): KINETIC INSTITUTE PHYSICAL THERAPY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 01/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 CARTHAGE ST
SANFORD NC
27330-8984
US

IV. Provider business mailing address

1210 CARTHAGE ST
SANFORD NC
27330-8984
US

V. Phone/Fax

Practice location:
  • Phone: 919-776-5488
  • Fax:
Mailing address:
  • Phone: 919-776-5488
  • 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: SCOTT AXNER
Title or Position: DIRECTOR
Credential:
Phone: 919-776-5488