Provider Demographics
NPI:1154335412
Name:THE KINETIC CHAIN PHYSICAL THERAPY
Entity type:Organization
Organization Name:THE KINETIC CHAIN PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JANA
Authorized Official - Middle Name:L
Authorized Official - Last Name:VANSURKSUM
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:949-552-9100
Mailing Address - Street 1:12 MAUCHLY STE A
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2394
Mailing Address - Country:US
Mailing Address - Phone:949-552-9100
Mailing Address - Fax:949-552-9102
Practice Address - Street 1:12 MAUCHLY STE A
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-2394
Practice Address - Country:US
Practice Address - Phone:949-552-9100
Practice Address - Fax:949-552-9102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT21471225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty