Provider Demographics
NPI:1285764936
Name:KINEMATIC CONCEPTS PHYSICAL THERAPY & SPORTS REHAB, PLLC
Entity type:Organization
Organization Name:KINEMATIC CONCEPTS PHYSICAL THERAPY & SPORTS REHAB, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:ELMS
Authorized Official - Suffix:
Authorized Official - Credentials:MPT, OCS, FAAOMPT
Authorized Official - Phone:210-372-9600
Mailing Address - Street 1:12952 BANDERA RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-4689
Mailing Address - Country:US
Mailing Address - Phone:210-372-9600
Mailing Address - Fax:210-372-9923
Practice Address - Street 1:12952 BANDERA RD
Practice Address - Street 2:SUITE 107
Practice Address - City:HELOTES
Practice Address - State:TX
Practice Address - Zip Code:78023-4689
Practice Address - Country:US
Practice Address - Phone:210-372-9600
Practice Address - Fax:210-372-9923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX647890002225100000X
TX562580001225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0084HNOtherBLUE CROSS BLUE SHIELD
TXDA8491OtherRAILROAD MEDICARE
TX1543670-01Medicaid
TX1543670-01Medicaid