Healthcare Provider Details

I. General information

NPI: 1861823908
Provider Name (Legal Business Name): KINEMATIC CONCEPTS PHYSICAL THERAPY & SPORTS REHAB, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2013
Last Update Date: 11/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7003 S NEW BRAUNFELS AVE SUITE 114
SAN ANTONIO TX
78223-4588
US

IV. Provider business mailing address

8627 CINNAMON CREEK DR SUITE 402
SAN ANTONIO TX
78240-1480
US

V. Phone/Fax

Practice location:
  • Phone: 210-892-0359
  • Fax: 210-253-9535
Mailing address:
  • Phone: 210-695-8731
  • Fax: 210-598-0432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number647890008
License Number StateTX

VIII. Authorized Official

Name: JOHN P. MALFER
Title or Position: PRESIDENT/CO-OWNER
Credential: PT
Phone: 210-695-8731