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General NPI Number Information
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NPI Number | 1043379282
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Entity Type | Organization
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Legal Business Name | KING CITY PHYSICAL THERAPY APC
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 06/03/2008
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Provider Practice Location Address
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Address Line | 200 BROADWAY ST STE 28
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City | KING CITY
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State | CA
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Zip | 93930-2865
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Country | US
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Telephone | 831-386-9710
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Fax |
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Provider Business Mailing Address
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Address Line | 200 BROADWAY ST STE 28
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City | KING CITY
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State | CA
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Zip | 93930-2865
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Country | US
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Telephone | 831-386-9710
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Fax |
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | MS. DEBBIE L ESTRADA
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Credential |
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Telephone | 805-227-4156
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT06391
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License Number State | CA
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