Provider Demographics
NPI:1528757804
Name:KINETIC MASSAGE WORKS
Entity type:Organization
Organization Name:KINETIC MASSAGE WORKS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICAELA
Authorized Official - Middle Name:
Authorized Official - Last Name:LIEM
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:281-757-5251
Mailing Address - Street 1:11027 NORTHPOINTE BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-1571
Mailing Address - Country:US
Mailing Address - Phone:281-757-5251
Mailing Address - Fax:
Practice Address - Street 1:11027 NORTHPOINTE BLVD STE D
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-1571
Practice Address - Country:US
Practice Address - Phone:281-757-5251
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty