MEDICARE: KINETIC KICKOFF LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	103T00000X	Psychologist
3	221700000X	Art Therapist
4	225100000X	Physical Therapist
5	2251P0200X	Pediatric Physical Therapist
6	225A00000X	Music Therapist
7	225X00000X	Occupational Therapist
8	225XF0002X	Feeding, Eating & Swallowing Occupational Therapist
9	225XG0600X	Gerontology Occupational Therapist
10	2355S0801X	Speech-Language Assistant
11	235Z00000X	Speech-Language Pathologist
12	252Y00000X	Early Intervention Provider Agency
13	253Z00000X	In Home Supportive Care Agency
14	224ZF0002X	Feeding, Eating & Swallowing Occupational Therapy Assistant

General Provider Information

NPI Number	:	1841056918
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINETIC KICKOFF LLC

Provider Business Mailing Address
First Line	:	275 NW 33RD AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33125-4924
Country	:	US
Telephone Number	:	305-606-3540
Fax Number	:

Provider Business Practice Location Address
First Line	:	1810 W KENNEDY BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33606-1645
Country	:	US
Telephone Number	:	305-342-0327
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	KRIZIA I FARAJ
Credential	:
Telephone Number	:	305-606-3540

Provider Enumeration Date	:	02/26/2024
Last Update Date	:	06/03/2025

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Directions to “KINETIC KICKOFF LLC ” Practice Location

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