Healthcare Provider Details

I. General information

NPI: 1033712328
Provider Name (Legal Business Name): KINETIC PELVIC HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2020
Last Update Date: 12/14/2022
Certification Date: 12/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 LUKE CT
CRANBERRY TOWNSHIP PA
16066-7915
US

IV. Provider business mailing address

515 LUKE CT
CRANBERRY TWP PA
16066-7915
US

V. Phone/Fax

Practice location:
  • Phone: 201-694-3364
  • Fax:
Mailing address:
  • Phone: 201-694-3364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: AMANDA THOMAS
Title or Position: OWNER
Credential: PT, DPT, CLT
Phone: 201-694-3364