Provider Demographics
NPI:1114441532
Name:KINETIC WELLNESS CENTER, LLC
Entity type:Organization
Organization Name:KINETIC WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SEBASTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CALVO
Authorized Official - Suffix:
Authorized Official - Credentials:CMA
Authorized Official - Phone:832-727-5056
Mailing Address - Street 1:7707 FANNIN ST STE 154
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-1918
Mailing Address - Country:US
Mailing Address - Phone:832-727-5056
Mailing Address - Fax:713-501-8933
Practice Address - Street 1:7707 FANNIN ST STE 154
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-1918
Practice Address - Country:US
Practice Address - Phone:832-727-5056
Practice Address - Fax:713-501-8933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherPHYSICAL MEDICINE