1386821619 NPI number — KIDS ON THE GO PHYSICAL THERAPY INC.

Table of content: (NPI 1386821619)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386821619 NPI number — KIDS ON THE GO PHYSICAL THERAPY INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KIDS ON THE GO 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:
KIDS ON THE GO THERAPIES
Provider Other Organization Name Type Code:
5
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:
1386821619
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/14/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7629 GIRARD AVE
Provider Second Line Business Mailing Address:
STE 201
Provider Business Mailing Address City Name:
LA JOLLA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92037-0076
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-495-6522
Provider Business Mailing Address Fax Number:
858-255-8364

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7629 GIRARD AVE
Provider Second Line Business Practice Location Address:
STE 201
Provider Business Practice Location Address City Name:
LA JOLLA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92037-0076
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-495-6522
Provider Business Practice Location Address Fax Number:
858-255-8364
Provider Enumeration Date:
01/29/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HERMES
Authorized Official First Name:
MARY
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICAL THERAPIST/ OWNER
Authorized Official Telephone Number:
773-495-6522

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  24707 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2251P0200X , with the licence number: 24707 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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