Provider Demographics
NPI:1063170447
Name:KINTSU PHYSICAL THERAPY AND WELLNESS, INC.
Entity type:Organization
Organization Name:KINTSU PHYSICAL THERAPY AND WELLNESS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, CSCS
Authorized Official - Phone:951-801-8083
Mailing Address - Street 1:2529 W KNOX AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-5549
Mailing Address - Country:US
Mailing Address - Phone:951-801-8083
Mailing Address - Fax:
Practice Address - Street 1:2529 W KNOX AVE
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-5549
Practice Address - Country:US
Practice Address - Phone:951-801-8083
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy