=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033773106
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KADALYST WELLNESS AND PHYSICAL THERAPY INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/24/2019
-----------------------------------------------------
Last Update Date | 08/20/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 191 LIGHTHOUSE AVE STE B
-----------------------------------------------------
City | MONTEREY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93940-1704
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-531-7177
-----------------------------------------------------
Fax | 831-515-8679
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 740 CROCKER AVE APT 20
-----------------------------------------------------
City | PACIFIC GROVE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93950-3737
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-916-6670
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FOUNDER
-----------------------------------------------------
Name | DR. NATHAN PAUL KADLECEK
-----------------------------------------------------
Credential | DPT
-----------------------------------------------------
Telephone | 408-916-6670
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------