MEDICARE: KINETIC STUDIO, 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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1548880024
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINETIC STUDIO, LLC

Provider Business Mailing Address
First Line	:	305 RICHMOND AVE
Second Line	:
City	:	SOUTH ORANGE
State	:	NJ
Zip	:	07079-2133
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	305 RICHMOND AVE
Second Line	:
City	:	SOUTH ORANGE
State	:	NJ
Zip	:	07079-2133
Country	:	US
Telephone Number	:	518-598-3737
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PT
Name	:	SARAH RIALE
Credential	:	PT, DPT
Telephone Number	:	518-598-3737

Provider Enumeration Date	:	04/24/2020
Last Update Date	:	04/24/2020

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Directions to “KINETIC STUDIO, LLC ” Practice Location

Language	Start Address	Practice Location

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