Organization
KINETICORE REHAB INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL MCNEALL (BOARD MEMBER)
(816) 964-0946
Entity
Organization
Contact information
Practice address
3006 RAVEN LN, CRESTVIEW, FL 32539-4368
(239) 401-3144
(239) 237-5366
Mailing address
PO BOX 127, CRESTVIEW, FL 32536-0127
(239) 401-3144
(239) 237-5366
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
—
—
225100000X
Physical Therapist
—
—
225200000X
Physical Therapy Assistant
—
—
225X00000X
Occupational Therapist
Primary
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Enumeration date
06/17/2025
Last updated
07/18/2025
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