Provider Demographics
NPI:1003280801
Name:NEXT LEVEL PHYSICAL THERAPY INC.
Entity Type:Organization
Organization Name:NEXT LEVEL PHYSICAL THERAPY INC.
Other - Org Name:NEXT LEVEL PHYSICAL THERAPY PERFORMANCE AND FITNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRINCIPAL/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:707-781-8062
Mailing Address - Street 1:719 SOUTHPOINT BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-1495
Mailing Address - Country:US
Mailing Address - Phone:707-781-8062
Mailing Address - Fax:707-981-8684
Practice Address - Street 1:719 SOUTHPOINT BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-1495
Practice Address - Country:US
Practice Address - Phone:707-781-8062
Practice Address - Fax:707-981-8684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-17
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27666225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty