Provider Demographics
NPI:1023079712
Name:KINEMATIC CONCEPTS PHYSICAL THERAPY & SPORTS REHAB, PLLC
Entity type:Organization
Organization Name:KINEMATIC CONCEPTS PHYSICAL THERAPY & SPORTS REHAB, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MALFER
Authorized Official - Suffix:
Authorized Official - Credentials:PT, ATC
Authorized Official - Phone:210-253-3888
Mailing Address - Street 1:12952 BANDERA RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-4689
Mailing Address - Country:US
Mailing Address - Phone:210-695-2682
Mailing Address - Fax:210-372-0211
Practice Address - Street 1:5441 BABCOCK RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-3989
Practice Address - Country:US
Practice Address - Phone:210-253-3888
Practice Address - Fax:210-253-3889
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KINEMATIC CONCEPTS PHYSICAL THERAPY & SPORTS REHAB, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-31
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX647890001225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0084HNOtherBLUE CROSS BLUE SHIELD
TX0084HNOtherBLUE CROSS BLUE SHIELD