{
"Npi": {
"NPI": "1447310099",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "KINETIC HEALTH SERVICES, LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1125 WEST STREET",
"SecondLineMailingAddress": "SUITE 304",
"MailingAddressCityName": "ANNAPOLIS",
"MailingAddressStateName": "MD",
"MailingAddressPostalCode": "21401-4198",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "703-622-9032",
"MailingAddressFaxNumber": "800-936-3359",
"FirstLinePracticeLocationAddress": "1125 WEST STREET",
"SecondLinePracticeLocationAddress": "SUITE 304",
"PracticeLocationAddressCityName": "ANNAPOLIS",
"PracticeLocationAddressStateName": "MD",
"PracticeLocationAddressPostalCode": "21401-4198",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "703-622-9032",
"PracticeLocationAddressFaxNumber": "800-936-3359",
"EnumerationDate": "12/12/2006",
"LastUpdateDate": "02/11/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MULVIHILL",
"AuthorizedOfficialFirstName": "TIMOTHY",
"AuthorizedOfficialMiddleName": "JOHN",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": "JR.",
"AuthorizedOfficialCredential": "A.T.,C.",
"AuthorizedOfficialTelephoneNumber": "703-622-9032",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "2255A2300X",
"TaxonomyName": "Athletic Trainer",
"LicenseNumber": "RT-001446-A",
"LicenseNumberStateCode": "PA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "332B00000X",
"TaxonomyName": "Durable Medical Equipment & Medical Supplies",
"LicenseNumber": "02171211",
"LicenseNumberStateCode": "MD",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "332BC3200X",
"TaxonomyName": "Customized Equipment (DME)",
"LicenseNumber": "02171211",
"LicenseNumberStateCode": "MD",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}