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Organization
KINETIC KIDS, INC.
Active
Organization
KINETIC KIDS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TIFFANI S. BACON PT, MPT (CO-FOUNDER & PHYSICAL THERAPIST)
(704) 807-5699
Entity
Organization
Contact information
Practice address
1016 EUCLID AVE, CHARLOTTE, NC 28203-4520
(704) 807-5699
(704) 631-4574
Mailing address
9611 BROOKDALE DR, SUITE 100-122, CHARLOTTE, NC 28215-8719
(704) 807-5699
(704) 631-4574
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
NC
252Y00000X
Early Intervention Provider Agency
—
NC
261QA3000X
Augmentative Communication Clinic/Center
—
NC
261QC1500X
Community Health Clinic/Center
—
NC
261QD1600X
Developmental Disabilities Clinic/Center
—
NC
261QH0100X
Health Service Clinic/Center
—
NC
261QH0700X
Hearing and Speech Clinic/Center
—
NC
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
NC
261QM1300X
Multi-Specialty Clinic/Center
—
NC
261QR0400X
Rehabilitation Clinic/Center
—
NC
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
Primary
—
NC
Other
Enumeration date
11/05/2008
Last updated
08/20/2015
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