Provider Demographics
NPI:1588084461
Name:KINETIX PT, INC.
Entity type:Organization
Organization Name:KINETIX PT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:HODGSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:805-286-4794
Mailing Address - Street 1:959 LAS TABLAS RD
Mailing Address - Street 2:SUITE A4
Mailing Address - City:TEMPLETON
Mailing Address - State:CA
Mailing Address - Zip Code:93465-9703
Mailing Address - Country:US
Mailing Address - Phone:805-286-4794
Mailing Address - Fax:805-926-3176
Practice Address - Street 1:959 LAS TABLAS RD
Practice Address - Street 2:SUITE A4
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-9703
Practice Address - Country:US
Practice Address - Phone:805-286-4794
Practice Address - Fax:805-926-3176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-18
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28027225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty