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General NPI Number Information
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NPI Number | 1497469100
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Entity Type | Organization
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Legal Business Name | KINETIC WELLNESS, LLC
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Dates
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Enumeration Date | 01/09/2023
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Last Update Date | 01/09/2023
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Provider Practice Location Address
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Address Line | 909 W MAIN ST
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City | GREEN FOREST
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State | AR
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Zip | 72638-2316
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Country | US
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Telephone | 618-960-7163
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Fax | 870-341-6282
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Provider Business Mailing Address
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Address Line | 1034 COUNTY ROAD 107
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City | EUREKA SPRINGS
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State | AR
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Zip | 72632-9476
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Country | US
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Telephone | 618-960-7163
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Fax | 870-341-6282
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Authorized Official
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Title or Position | OFFICER/MANAGER
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Name | JESSICA ANN DURR
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Credential | DPT
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Telephone | 618-960-7263
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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