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General NPI Number Information
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NPI Number | 1831862903
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Entity Type | Organization
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Legal Business Name | KINETIC PHYSICAL THERAPY PLLC
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Dates
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Enumeration Date | 07/26/2021
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Last Update Date | 09/07/2021
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Provider Practice Location Address
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Address Line | 5089 W HERRIMAN BLVD STE 2B
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City | HERRIMAN
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State | UT
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Zip | 84096-2599
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Country | US
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Telephone | 480-206-1591
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Fax |
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Provider Business Mailing Address
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Address Line | 17939 E APPALOOSA DR
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City | QUEEN CREEK
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State | AZ
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Zip | 85142-4529
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Country | US
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Telephone | 480-206-1591
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Fax |
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Authorized Official
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Title or Position | CEO/OWNER
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Name | MR. SEAN AARON MILLER
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Credential | PT
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Telephone | 480-206-1591
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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