Provider Demographics
NPI:1104538305
Name:KINESIO LAB PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:KINESIO LAB PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:MARQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:609-766-7654
Mailing Address - Street 1:300 CARNEGIE CTR
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-6249
Mailing Address - Country:US
Mailing Address - Phone:609-766-7654
Mailing Address - Fax:
Practice Address - Street 1:281 DUNNS MILL ROAD
Practice Address - Street 2:
Practice Address - City:BORDENTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08505
Practice Address - Country:US
Practice Address - Phone:609-766-7654
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-19
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty