=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740831569
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | K2 PHYSICAL THERAPY, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/23/2019
-----------------------------------------------------
Last Update Date | 03/16/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2340 GARDEN RD STE 101
-----------------------------------------------------
City | MONTEREY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93940-5347
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-250-0017
-----------------------------------------------------
Fax | 831-920-3739
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2340 GARDEN RD STE 101
-----------------------------------------------------
City | MONTEREY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93940-5347
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-250-0017
-----------------------------------------------------
Fax | 831-920-3739
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICAL THERAPIST
-----------------------------------------------------
Name | GAGE BANKS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 831-250-0017
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------