Provider Demographics
NPI:1699172031
Name:KINSMAN REHAB SERVICES
Entity type:Organization
Organization Name:KINSMAN REHAB SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRINCIPLE
Authorized Official - Prefix:MR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KINSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:508-254-1233
Mailing Address - Street 1:1900 OFARRELL ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-1386
Mailing Address - Country:US
Mailing Address - Phone:650-645-1100
Mailing Address - Fax:
Practice Address - Street 1:1900 OFARRELL ST
Practice Address - Street 2:SUITE 110
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-1386
Practice Address - Country:US
Practice Address - Phone:650-645-1100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-01
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA022-0638-1261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy