Provider Demographics
NPI:1659930287
Name:KINETIX PHYSICAL THERAPY PC
Entity type:Organization
Organization Name:KINETIX PHYSICAL THERAPY PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MELVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:347-728-5499
Mailing Address - Street 1:1751 VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-3513
Mailing Address - Country:US
Mailing Address - Phone:718-252-0625
Mailing Address - Fax:718-252-0615
Practice Address - Street 1:1751 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-3513
Practice Address - Country:US
Practice Address - Phone:718-252-0625
Practice Address - Fax:718-252-0615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty