Healthcare Provider Details

I. General information

NPI: 1609117829
Provider Name (Legal Business Name): MKC PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2013
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 JAMACHA RD SUITE 203
EL CAJON CA
92019-6206
US

IV. Provider business mailing address

PO BOX 2736
SPRING VALLEY CA
91979-2736
US

V. Phone/Fax

Practice location:
  • Phone: 619-573-6373
  • Fax: 619-378-6578
Mailing address:
  • Phone: 619-573-6373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW CAZALAS
Title or Position: OFFICE MANAGER
Credential:
Phone: 619-573-6373