MEDICARE: KAOF SPORTS THERAPEUTIC GUIDANCE GROUP 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1134774805
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAOF SPORTS THERAPEUTIC GUIDANCE GROUP LLC

Provider Business Mailing Address
First Line	:	2000 FOREST RIDGE DR
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29715-6432
Country	:	US
Telephone Number	:	803-526-6665
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 FOREST RIDGE DR
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29715-6432
Country	:	US
Telephone Number	:	803-526-6665
Fax Number	:

Authorized Official
Title or Position	:	OFFICER
Name	:	MS. MELISSA L KENYON
Credential	:
Telephone Number	:	803-526-6665

Provider Enumeration Date	:	08/08/2019
Last Update Date	:	08/08/2019

Similar Medicare Providers

1548388135 — DR. BOB W DEASON DDS
Practice Location Address:

765 MILL CREEK RD
JACKSONVILLE, FL
32211-6432

Practice Phone: 904-724-6321
Practice Fax: 904-721-6151

1861723777 — BOB W. DEASON, DDS, PA
Practice Location Address:

765 MILL CREEK RD
JACKSONVILLE, FL
32211-6432

Practice Phone: 904-724-6321
Practice Fax: 904-721-6151

1558401653 — FORT STOCKTON ISD
Practice Location Address:

1200 W 2ND ST
FORT STOCKTON, TX
79735-6432

Practice Phone: 432-336-4040
Practice Fax:

1750732608 — MALESHA LASHAE GRAHAM
Practice Location Address:

2839 EVANS AVE
FORT MYERS, FL
33901-6432

Practice Phone: 863-257-9506
Practice Fax:

1588140131 — ALLIANCE PHARMACY LLC
Practice Location Address:

9601 N BEACH ST STE 105
FORT WORTH, TX
76244-6432

Practice Phone: 409-293-9399
Practice Fax:

1891348934 — ALEX FENG
Practice Location Address:

9601 N BEACH ST STE 105
FORT WORTH, TX
76244-6432

Practice Phone: 817-952-1999
Practice Fax:

Directions to “KAOF SPORTS THERAPEUTIC GUIDANCE GROUP LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.