1033773106 NPI number — KADALYST WELLNESS AND PHYSICAL THERAPY INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033773106 NPI number — KADALYST WELLNESS AND PHYSICAL THERAPY INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KADALYST WELLNESS AND PHYSICAL THERAPY INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033773106
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/20/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
740 CROCKER AVE APT 20
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PACIFIC GROVE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93950-3737
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-916-6670
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
191 LIGHTHOUSE AVE STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTEREY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93940-1704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-531-7177
Provider Business Practice Location Address Fax Number:
831-515-8679
Provider Enumeration Date:
04/24/2019

Additional Information

Authorized Official

Authorized Official Last Name:
KADLECEK
Authorized Official First Name:
NATHAN
Authorized Official Middle Name:
PAUL
Authorized Official Title or Position:
FOUNDER
Authorized Official Telephone Number:
408-916-6670

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com