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General NPI Number Information
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NPI Number | 1235670373
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Entity Type | Organization
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Legal Business Name | KINETIC REHABILITATION INC.
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Dates
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Enumeration Date | 03/08/2017
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Last Update Date | 03/08/2017
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Provider Practice Location Address
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Address Line | 22180 PONTIAC TRL
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City | SOUTH LYON
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State | MI
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Zip | 48178-9097
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Country | US
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Telephone | 248-446-0155
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Fax |
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Provider Business Mailing Address
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Address Line | 9865 LAPHAM WAY
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City | PLYMOUTH
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State | MI
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Zip | 48170-5854
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANDREA KONJA
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Credential | DPT
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Telephone | 248-722-1617
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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