=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043672066
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KINETICA PHYSICAL THERAPY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/29/2016
-----------------------------------------------------
Last Update Date | 03/29/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5300 WOODMERE DR SUITE 105
-----------------------------------------------------
City | BAKERSFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93313-2796
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 575-441-4887
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5300 WOODMERE DR SUITE 105
-----------------------------------------------------
City | BAKERSFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93313-2796
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 575-441-4887
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | JUPITER LABASAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 575-441-4887
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number | 40587
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------