NPIMap

Organization Active NPI

Kinetic Kids, Inc.

  • Comprehensive Outpatient Rehabilitation Facility (CORF)
  • Charlotte, NC
National Provider Identifier
1891949707
Registry record updated Aug 20, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Comprehensive Outpatient Rehabilitation Facility (CORF)Taxonomy code 261QR0401X
Legal business name
KINETIC KIDS, INC.
Practice address
1016 Euclid Ave
Charlotte, NC 28203-4520
Phone
(704) 807-5699
Fax
(704) 631-4574
NPI assigned
Nov 5, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2015

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

Authorized official

Name
Mrs. Tiffani S. Bacon, PT, MPT
Title
Co-Founder & Physical Therapist
Phone
(704) 807-5699

Specialties & licenses 11

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X NC
Early Intervention Provider Agency 252Y00000X NC
Augmentative Communication Clinic/Center 261QA3000X NC
Community Health Clinic/Center 261QC1500X NC
Developmental Disabilities Clinic/Center 261QD1600X NC
Health Service Clinic/Center 261QH0100X NC
Hearing and Speech Clinic/Center 261QH0700X NC
Adolescent and Children Mental Health Clinic/Center 261QM0855X NC
Multi-Specialty Clinic/Center 261QM1300X NC
Rehabilitation Clinic/Center 261QR0400X NC
Comprehensive Outpatient Rehabilitation Facility (CORF) 261QR0401X NC Primary

Addresses

Primary practice location

1016 Euclid Ave
Charlotte, NC 28203-4520

Mailing address

9611 Brookdale Dr
Suite 100-122
Charlotte, NC 28215-8719
Phone (704) 807-5699

Other identifiers 1

IdentifierTypeStateIssuer
7200262MedicaidNC

National Provider Directory

National Provider Directory

Locations

1016 Euclid Ave
Charlotte, NC 28203
Phone (704) 426-3955

Practitioners & affiliated clinicians

Practitioners 21

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1225843200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1440028800000",
    "number": "1891949707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9611 BROOKDALE DR",
            "address_2": "SUITE 100-122",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282158719",
            "telephone_number": "704-807-5699",
            "fax_number": "704-631-4574"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1016 EUCLID AVE",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282034520",
            "telephone_number": "704-807-5699",
            "fax_number": "704-631-4574"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KINETIC KIDS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-05",
        "last_updated": "2015-08-20",
        "status": "A",
        "authorized_official_last_name": "BACON",
        "authorized_official_first_name": "TIFFANI",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "CO-FOUNDER & PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "704-807-5699",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "PT, MPT"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "NC",
            "license": null,
            "primary": false
        },
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": "NC",
            "license": null,
            "primary": false
        },
        {
            "code": "261QA3000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Augmentative Communication",
            "state": "NC",
            "license": null,
            "primary": false
        },
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "NC",
            "license": null,
            "primary": false
        },
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": "NC",
            "license": null,
            "primary": false
        },
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "NC",
            "license": null,
            "primary": false
        },
        {
            "code": "261QH0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Hearing and Speech",
            "state": "NC",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "NC",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NC",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": "NC",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0401X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7200262",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.