Healthcare Provider Details

I. General information

NPI: 1972140952
Provider Name (Legal Business Name): KENIA G BABCHANIK DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2019
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

685 TWELVE BRIDGES DR STE A
LINCOLN CA
95648-8689
US

IV. Provider business mailing address

PO BOX 255228
SACRAMENTO CA
95865-5228
US

V. Phone/Fax

Practice location:
  • Phone: 916-408-5455
  • Fax: 916-408-5454
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT297826
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: