Healthcare Provider Details

I. General information

NPI: 1215910609
Provider Name (Legal Business Name): KIRK CHARLES ZOBAC PHYSICAL THERAPIST
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 N JACKSON AVE #104
SAN JOSE CA
95116-1903
US

IV. Provider business mailing address

PO BOX 612260
SAN JOSE CA
95161-2260
US

V. Phone/Fax

Practice location:
  • Phone: 408-254-7730
  • Fax: 408-254-7366
Mailing address:
  • Phone: 877-325-2776
  • Fax: 408-945-4011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT16419
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: