Healthcare Provider Details

I. General information

NPI: 1356772610
Provider Name (Legal Business Name): KINETIX FITNESS THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2013
Last Update Date: 12/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

848 N RAINBOW BLVD SUITE 156
LAS VEGAS NV
89107-1103
US

IV. Provider business mailing address

848 N RAINBOW BLVD SUITE 156
LAS VEGAS NV
89107-1103
US

V. Phone/Fax

Practice location:
  • Phone: 928-201-6660
  • Fax:
Mailing address:
  • Phone: 928-201-6660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code132700000X
TaxonomyDietary Manager
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code226300000X
TaxonomyKinesiotherapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: CARLOS SANCHEZ
Title or Position: MEMBER
Credential:
Phone: 928-201-6660