MEDICARE: KINNEY PHYSICAL THERAPY & WELLNESS,P.C.

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	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1679017842
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINNEY PHYSICAL THERAPY & WELLNESS,P.C.

Provider Business Mailing Address
First Line	:	605 HAMPSHIRE RD
Second Line	:	#434
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91361-2382
Country	:	US
Telephone Number	:	805-444-9546
Fax Number	:

Provider Business Practice Location Address
First Line	:	2955 E HILLCREST DR
Second Line	:	#108
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91362-3176
Country	:	US
Telephone Number	:	805-494-3131
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DANIEL KINNEY
Credential	:	PT
Telephone Number	:	805-444-9546

Provider Enumeration Date	:	12/07/2016
Last Update Date	:	12/07/2016

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