Provider Demographics
NPI:1194312538
Name:REKINECTED PHYSICAL THERAPY, INC
Entity type:Organization
Organization Name:REKINECTED PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL/PARTNER/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:
Authorized Official - Last Name:REVELL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:760-331-8111
Mailing Address - Street 1:3141 TIGER RUN CT STE 114
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92010-6706
Mailing Address - Country:US
Mailing Address - Phone:760-331-8111
Mailing Address - Fax:
Practice Address - Street 1:3141 TIGER RUN CT STE 114
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92010-6706
Practice Address - Country:US
Practice Address - Phone:760-331-8111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty