Healthcare Provider Details

I. General information

NPI: 1477524635
Provider Name (Legal Business Name): EDWARD J. KANE PT,PHD,ATC,ECS,SCS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 08/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 WINDY POINT DR
SAN MARCOS CA
92069-1701
US

IV. Provider business mailing address

700 WINDY POINT DR
SAN MARCOS CA
92069-1701
US

V. Phone/Fax

Practice location:
  • Phone: 760-591-3012
  • Fax: 760-591-3053
Mailing address:
  • Phone: 760-591-3012
  • Fax: 760-591-3053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11437
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2251E1300X
TaxonomyClinical Electrophysiology Physical Therapist
License Number41
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: