Provider Demographics
NPI:1053143420
Name:KINETIC GRAY PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:KINETIC GRAY PHYSICAL THERAPY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:CONNOR
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGHEE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:207-657-5600
Mailing Address - Street 1:PO BOX 1047
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:ME
Mailing Address - Zip Code:04039-1047
Mailing Address - Country:US
Mailing Address - Phone:207-657-5600
Mailing Address - Fax:855-464-0106
Practice Address - Street 1:205 PORTLAND RD STE 4
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:ME
Practice Address - Zip Code:04039-8906
Practice Address - Country:US
Practice Address - Phone:207-657-5600
Practice Address - Fax:855-464-0106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-15
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty