Provider Demographics
NPI:1528425642
Name:KINETIC REHAB, PLLC
Entity type:Organization
Organization Name:KINETIC REHAB, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WEBSTER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:517-262-1199
Mailing Address - Street 1:1331 HORTON RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-5297
Mailing Address - Country:US
Mailing Address - Phone:517-748-7747
Mailing Address - Fax:517-748-7745
Practice Address - Street 1:1331 HORTON RD
Practice Address - Street 2:SUITE B
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-5297
Practice Address - Country:US
Practice Address - Phone:517-748-7747
Practice Address - Fax:517-748-7745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-20
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501015290261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy