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General NPI Number Information
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NPI Number | 1659898559
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Entity Type | Organization
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Legal Business Name | MK PHYSICAL THERAPY INC
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Dates
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Enumeration Date | 08/23/2017
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Last Update Date | 02/12/2024
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Provider Practice Location Address
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Address Line | 4295 GESNER ST STE 3C1
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City | SAN DIEGO
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State | CA
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Zip | 92117-6663
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Country | US
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Telephone | 877-827-8246
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Fax |
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Provider Business Mailing Address
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Address Line | 4295 GESNER ST STE 3C1
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City | SAN DIEGO
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State | CA
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Zip | 92117-6663
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Country | US
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Telephone | 877-827-8246
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Fax |
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Authorized Official
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Title or Position | OWNER / PROVIDER
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Name | CHARLES BENJAMIN KRETCHEK
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Credential | DPT
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Telephone | 877-827-8246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State |
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