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General NPI Number Information
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NPI Number | 1326961087
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Entity Type | Organization
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Legal Business Name | KINETIC BODYWORK CENTER
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Dates
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Enumeration Date | 07/31/2026
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Last Update Date | 07/31/2026
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Provider Practice Location Address
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Address Line | 29607 BARNES AVE
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City | FORT GORDON
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State | GA
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Zip | 30905
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Country | US
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Telephone | 706-262-5087
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Fax |
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Provider Business Mailing Address
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Address Line | 3637 ALENE CIR
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City | AUGUSTA
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State | GA
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Zip | 30906-4356
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Country | US
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Telephone | 706-262-5087
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Fax |
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Authorized Official
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Title or Position | THERAPIST / OWNER
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Name | MR. BENIGNO A. OLIVARES
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Credential | LMT
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Telephone | 706-262-5087
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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