MEDICARE: KINETIC WELLNESS CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician

General Provider Information

NPI Number	:	1114441532
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINETIC WELLNESS CENTER, LLC

Provider Business Mailing Address
First Line	:	7707 FANNIN ST STE 154
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-1918
Country	:	US
Telephone Number	:	832-727-5056
Fax Number	:	713-501-8933

Provider Business Practice Location Address
First Line	:	7707 FANNIN ST STE 154
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-1918
Country	:	US
Telephone Number	:	832-727-5056
Fax Number	:	713-501-8933

Authorized Official
Title or Position	:	PARTNER/MANAGER
Name	:	SEBASTIAN CALVO
Credential	:	CMA
Telephone Number	:	832-727-5056

Provider Enumeration Date	:	07/27/2017
Last Update Date	:	07/21/2022

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