Provider Demographics
NPI:1083652069
Name:KINETIC ENERGY PHYSICAL THERAPY PC
Entity type:Organization
Organization Name:KINETIC ENERGY PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARCO
Authorized Official - Middle Name:J
Authorized Official - Last Name:RABANAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-879-8026
Mailing Address - Street 1:PO BOX 883299
Mailing Address - Street 2:
Mailing Address - City:STEAMBOAT SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80488-3299
Mailing Address - Country:US
Mailing Address - Phone:970-879-8026
Mailing Address - Fax:970-879-8046
Practice Address - Street 1:1585 MID VALLEY DR
Practice Address - Street 2:#3
Practice Address - City:STEAMBOAT SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80487-9098
Practice Address - Country:US
Practice Address - Phone:970-879-8026
Practice Address - Fax:970-879-8046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCP9703Medicare UPIN