MEDICARE: KIRK CHARLES ZOBAC PHYSICAL THERAPIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT16419	CA

General Provider Information

NPI Number	:	1215910609
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRK CHARLES ZOBAC PHYSICAL THERAPIST

Provider Business Mailing Address
First Line	:	PO BOX 612260
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95161-2260
Country	:	US
Telephone Number	:	877-325-2776
Fax Number	:	408-945-4011

Provider Business Practice Location Address
First Line	:	125 N JACKSON AVE
Second Line	:	#104
City	:	SAN JOSE
State	:	CA
Zip	:	95116-1903
Country	:	US
Telephone Number	:	408-254-7730
Fax Number	:	408-254-7366

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2005
Last Update Date	:	07/08/2007

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