Provider Demographics
NPI:1285526863
Name:STELLAR KINETICS LLC
Entity type:Organization
Organization Name:STELLAR KINETICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:KSIONDA
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:520-609-4324
Mailing Address - Street 1:3019 W SPENCER ST STE 104
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-5946
Mailing Address - Country:US
Mailing Address - Phone:520-609-4324
Mailing Address - Fax:
Practice Address - Street 1:3019 W SPENCER ST STE 104
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-5946
Practice Address - Country:US
Practice Address - Phone:520-609-4324
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-17
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)