Provider Demographics
NPI:1457607889
Name:KINETA REHAB SOLUTIONS, LLC
Entity type:Organization
Organization Name:KINETA REHAB SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:C
Authorized Official - Last Name:JEFFERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPTA
Authorized Official - Phone:703-587-1907
Mailing Address - Street 1:53 S GORDON ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-4929
Mailing Address - Country:US
Mailing Address - Phone:703-587-1907
Mailing Address - Fax:571-970-6125
Practice Address - Street 1:53 S GORDON ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-4929
Practice Address - Country:US
Practice Address - Phone:703-587-1907
Practice Address - Fax:571-970-6125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-03
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306601555171W00000X
VA0119003001171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Multi-Specialty