# KINETIC KIDS, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1891949707
- **Authorized official:** MRS. TIFFANI S. BACON PT, MPT (CO-FOUNDER & PHYSICAL THERAPIST)
- **Authorized official phone:** (704) 807-5699

## Contact information

- **Practice address:** 1016 EUCLID AVE, CHARLOTTE, NC 28203-4520
- **Practice address phone:** (704) 807-5699
- **Practice address fax:** (704) 631-4574
- **Mailing address:** 9611 BROOKDALE DR, SUITE 100-122, CHARLOTTE, NC 28215-8719
- **Mailing address phone:** (704) 807-5699
- **Mailing address fax:** (704) 631-4574

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 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) | — | NC | Yes |

## Other

- **Enumeration date:** 11/05/2008
- **Last updated:** 08/20/2015