MEDICARE: KINEMATIC CONCEPTS PHYSICAL THERAPY & SPORTS REHAB, PLLC

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	647890008	TX

General Provider Information

NPI Number	:	1861823908
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINEMATIC CONCEPTS PHYSICAL THERAPY & SPORTS REHAB, PLLC

Provider Business Mailing Address
First Line	:	8627 CINNAMON CREEK DR
Second Line	:	SUITE 402
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-1480
Country	:	US
Telephone Number	:	210-695-8731
Fax Number	:	210-598-0432

Provider Business Practice Location Address
First Line	:	7003 S NEW BRAUNFELS AVE
Second Line	:	SUITE 114
City	:	SAN ANTONIO
State	:	TX
Zip	:	78223-4588
Country	:	US
Telephone Number	:	210-892-0359
Fax Number	:	210-253-9535

Authorized Official
Title or Position	:	PRESIDENT/CO-OWNER
Name	:	JOHN P. MALFER
Credential	:	PT
Telephone Number	:	210-695-8731

Provider Enumeration Date	:	11/27/2013
Last Update Date	:	11/27/2013

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