1982395968 NPI number — PHYSIO KAI SPORTS PERFORMANCE & PHYSICAL THERAPY

Table of content: MISS CHESLEY ELISE FOXWORTH MA (NPI 1275099582)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982395968 NPI number — PHYSIO KAI SPORTS PERFORMANCE & PHYSICAL THERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHYSIO KAI SPORTS PERFORMANCE & PHYSICAL THERAPY
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:
1982395968
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2550 CANYON SPRINGS PKWY STE I
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIVERSIDE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92507-0951
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:
951-261-5474

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1827 REDFIELD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIVERSIDE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92507-7817
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-879-9716
Provider Business Practice Location Address Fax Number:
951-261-5474
Provider Enumeration Date:
05/19/2023

Additional Information

Authorized Official

Authorized Official Last Name:
VIZCARRA
Authorized Official First Name:
SOFIA
Authorized Official Middle Name:
NATALIA
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
760-879-9716

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