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General NPI Number Information
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NPI Number | 1114978376
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Entity Type | Organization
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Legal Business Name | KINETIC PHYSICAL THERAPY, INC
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Dates
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Enumeration Date | 05/13/2006
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Last Update Date | 12/07/2010
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Provider Practice Location Address
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Address Line | 132 HOLIDAY CT SUITE 203
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City | ANNAPOLIS
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State | MD
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Zip | 21401-7005
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Country | US
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Telephone | 410-573-9930
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Fax | 410-573-9932
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Provider Business Mailing Address
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Address Line | 132 HOLIDAY CT SUITE 203
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City | ANNAPOLIS
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State | MD
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Zip | 21401-7005
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Country | US
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Telephone | 410-573-9930
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Fax | 410-573-9932
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Authorized Official
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Title or Position | PHYSICAL THERAPIST, MSPT
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Name | MR. STEPHEN JOSEPH SODERO
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Credential | MSPT
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Telephone | 410-573-9930
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 20542
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License Number State | MD
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