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General NPI Number Information
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NPI Number | 1972667947
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Entity Type | Organization
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Legal Business Name | MITCHELL KAUK
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Dates
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Enumeration Date | 12/21/2006
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Last Update Date | 05/16/2013
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Provider Practice Location Address
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Address Line | 224A WELLER ST
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City | PETALUMA
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State | CA
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Zip | 94952-3136
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Country | US
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Telephone | 707-762-7678
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Fax | 707-762-7679
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Provider Business Mailing Address
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Address Line | 224A WELLER ST
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City | PETALUMA
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State | CA
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Zip | 94952-3136
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Country | US
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Telephone | 707-762-7678
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Fax | 707-762-7679
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Authorized Official
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Title or Position | OWNER DIRECTOR
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Name | MR. MITCHELL KAUK
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Credential | PT OCS
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Telephone | 707-762-7678
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | PT10959
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License Number State | CA
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