Provider Demographics
NPI:1033773106
Name:KADALYST WELLNESS AND PHYSICAL THERAPY INC.
Entity Type:Organization
Organization Name:KADALYST WELLNESS AND PHYSICAL THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:KADLECEK
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:408-916-6670
Mailing Address - Street 1:740 CROCKER AVE APT 20
Mailing Address - Street 2:
Mailing Address - City:PACIFIC GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:93950-3737
Mailing Address - Country:US
Mailing Address - Phone:408-916-6670
Mailing Address - Fax:
Practice Address - Street 1:191 LIGHTHOUSE AVE STE B
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-1704
Practice Address - Country:US
Practice Address - Phone:831-531-7177
Practice Address - Fax:831-515-8679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-24
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty