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General NPI Number Information
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NPI Number | 1144847054
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Entity Type | Organization
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Legal Business Name | KINECT THERAPY SERVICES
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Dates
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Enumeration Date | 06/26/2020
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Last Update Date | 06/26/2020
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Provider Practice Location Address
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Address Line | 596 SE NOME DR
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34984-8944
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Country | US
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Telephone | 772-301-4458
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Fax |
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Provider Business Mailing Address
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Address Line | 596 SE NOME DR
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34984-8944
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Country | US
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Telephone | 772-301-4458
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Fax |
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Authorized Official
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Title or Position | OMGR
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Name | LLANA DALEY BOWEN
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Credential | OTR/L
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Telephone | 772-772-7082
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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