MEDICARE: KINETIC HEALTH SERVICES, 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	2255A2300X	Athletic Trainer	RT-001446-A	PA
2	332B00000X	Durable Medical Equipment & Medical Supplies	02171211	MD
3	332BC3200X	Customized Equipment (DME)	02171211	MD

General Provider Information

NPI Number	:	1447310099
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINETIC HEALTH SERVICES, LLC

Provider Business Mailing Address
First Line	:	1125 WEST STREET
Second Line	:	SUITE 304
City	:	ANNAPOLIS
State	:	MD
Zip	:	21401-4198
Country	:	US
Telephone Number	:	703-622-9032
Fax Number	:	800-936-3359

Provider Business Practice Location Address
First Line	:	1125 WEST STREET
Second Line	:	SUITE 304
City	:	ANNAPOLIS
State	:	MD
Zip	:	21401-4198
Country	:	US
Telephone Number	:	703-622-9032
Fax Number	:	800-936-3359

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. TIMOTHY JOHN MULVIHILL JR.
Credential	:	A.T.,C.
Telephone Number	:	703-622-9032

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	02/11/2025

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