Provider Demographics
NPI:1104477199
Name:SUBLIME KINETICS, LLC
Entity type:Organization
Organization Name:SUBLIME KINETICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:SUBLETT
Authorized Official - Suffix:JR
Authorized Official - Credentials:PT
Authorized Official - Phone:404-985-2351
Mailing Address - Street 1:180 NE 29TH ST PH 2006
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-5244
Mailing Address - Country:US
Mailing Address - Phone:404-985-2351
Mailing Address - Fax:
Practice Address - Street 1:180 NE 29TH ST PH 2006
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-5244
Practice Address - Country:US
Practice Address - Phone:404-985-2351
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy