NPIMap

Organization Active NPI

Kinetic Phys Therapy and Wellness Inc

  • Physical Therapy Clinic/Center
  • Greenville, NC
National Provider Identifier
1063733442
Registry record updated Jun 13, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
KINETIC PHYS THERAPY AND WELLNESS INC
Practice address
1540 E Arlington Blvd
Greenville, NC 27858-5870
Phone
(252) 364-2806
Fax
(252) 364-2863
NPI assigned
Jun 19, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Charlie David Edwards, PT, DPT
Title
President
Phone
(252) 902-7061

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X Primary

Addresses

Primary practice location

1540 E Arlington Blvd
Greenville, NC 27858-5870

Mailing address

1540 E Arlington Blvd
Greenville, NC 27858-5870
Phone (252) 364-2806

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100831000353 NC Part B Supplier - Clinic/Group Practice 5496879256 Receives reassigned benefits from 28 practitioners
Practice locations: Greenville, NC

National Provider Directory

National Provider Directory
Tax ID family
Kinetic Phys Therapy and Wellness Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1330 E Arlington Blvd
Ste C
Greenville, NC 27858

1350 E Arlington Blvd
Ste A
Greenville, NC 27858
Phone (252) 364-2806

Practitioners & affiliated clinicians

Practitioners 33

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 33

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1276905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1465776000000",
    "number": "1063733442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1540 E ARLINGTON BLVD",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278585870",
            "telephone_number": "252-364-2806",
            "fax_number": "252-364-2863"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1540 E ARLINGTON BLVD",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278585870",
            "telephone_number": "252-364-2806",
            "fax_number": "252-364-2863"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KINETIC PHYS THERAPY AND WELLNESS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-19",
        "last_updated": "2016-06-13",
        "status": "A",
        "authorized_official_last_name": "EDWARDS",
        "authorized_official_first_name": "CHARLIE",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "252-902-7061",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PT, DPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.