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General NPI Number Information
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NPI Number | 1255915674
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Entity Type | Organization
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Legal Business Name | KCG PHYSICAL THERAPY AND WELLNESS SVCS, INC
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Dates
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Enumeration Date | 05/11/2021
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Last Update Date | 05/11/2021
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Provider Practice Location Address
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Address Line | 610 WILLOW ST APT A
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City | ALAMEDA
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State | CA
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Zip | 94501-5714
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Country | US
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Telephone | 812-581-0011
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Fax |
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Provider Business Mailing Address
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Address Line | 1267 WILLIS ST STE 200A
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City | REDDING
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State | CA
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Zip | 96001-0400
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Country | US
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Telephone | 530-232-5985
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHRISTINE RIVERA-GAPUZ
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Credential | PT, DPT
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Telephone | 812-581-0011
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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 |
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License Number State |
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