Healthcare Provider Details

I. General information

NPI: 1922755958
Provider Name (Legal Business Name): KINEMATICS AND PROSTHETICS REHABILITATION INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2022
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8035 E RL THRTN FWY STE 324
DALLAS TX
75228-7072
US

IV. Provider business mailing address

4714 COYOTE TRL
DALLAS TX
75227-2821
US

V. Phone/Fax

Practice location:
  • Phone: 321-217-9297
  • Fax:
Mailing address:
  • Phone: 321-217-9297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. BILLY GORDON
Title or Position: PROSTHETIST
Credential: LP, CP
Phone: 321-217-9297