Healthcare Provider Details

I. General information

NPI: 1477418754
Provider Name (Legal Business Name): PAUL KALCIC II DPT, PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6826 S CENTINELA AVE
CULVER CITY CA
90230-6301
US

IV. Provider business mailing address

6826 S CENTINELA AVE
CULVER CITY CA
90230-6301
US

V. Phone/Fax

Practice location:
  • Phone: 310-915-6100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number309424
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: