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General NPI Number Information
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NPI Number | 1710426093
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Entity Type | Organization
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Legal Business Name | ADVANCED KINETICS CORP
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Dates
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Enumeration Date | 02/20/2017
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Last Update Date | 02/20/2017
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Provider Practice Location Address
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Address Line | 16381 NW 13TH ST
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City | PEMBROKE PINES
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State | FL
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Zip | 33028-1309
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Country | US
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Telephone | 305-333-0284
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Fax | 888-855-6681
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Provider Business Mailing Address
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Address Line | 16381 NW 13TH ST
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City | PEMBROKE PINES
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State | FL
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Zip | 33028-1309
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Country | US
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Telephone | 305-333-0284
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Fax | 888-855-6681
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. GLORIA MARCELA GRAJALES
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Credential | OTR
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Telephone | 305-333-0284
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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 | 13889
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License Number State | FL
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