Provider Demographics
NPI:1962272757
Name:ON THE GO KINESIO
Entity type:Organization
Organization Name:ON THE GO KINESIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PT
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNA
Authorized Official - Middle Name:
Authorized Official - Last Name:WEIDINGER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:714-356-4440
Mailing Address - Street 1:20886 DESERT WOODS DR
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-2836
Mailing Address - Country:US
Mailing Address - Phone:573-680-2276
Mailing Address - Fax:
Practice Address - Street 1:20886 DESERT WOODS DR
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-2836
Practice Address - Country:US
Practice Address - Phone:573-680-2276
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health