Provider Demographics
NPI:1528323292
Name:KINETIC KIDS, INC
Entity type:Organization
Organization Name:KINETIC KIDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:GOBER
Authorized Official - Suffix:
Authorized Official - Credentials:MSOT, OTR/L, C-SIPT
Authorized Official - Phone:305-778-9198
Mailing Address - Street 1:1000 WEST AVE
Mailing Address - Street 2:#1411
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-4759
Mailing Address - Country:US
Mailing Address - Phone:305-778-9198
Mailing Address - Fax:305-535-1361
Practice Address - Street 1:11251 NW 20TH ST
Practice Address - Street 2:#118
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-1859
Practice Address - Country:US
Practice Address - Phone:305-778-9198
Practice Address - Fax:305-535-1361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14828261QD1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities