1386821619 NPI number — KIDS ON THE GO 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 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:
Provider Other Organization Name Type Code:
6
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: 2251P0200X , with the licence number:  24707 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • 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" .

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





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