Healthcare Provider Details

I. General information

NPI: 1184612541
Provider Name (Legal Business Name): KORY PAUL FELKER M.P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 09/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78 E CENTRAL AVE SUITE 2
QUINCY CA
95971-9718
US

IV. Provider business mailing address

78 E CENTRAL AVE SUITE 2
QUINCY CA
95971-9718
US

V. Phone/Fax

Practice location:
  • Phone: 530-283-2202
  • Fax: 530-283-2204
Mailing address:
  • Phone: 530-283-2202
  • Fax: 530-283-2204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT8023
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: