Provider Demographics
NPI:1083182265
Name:KAIZEN PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:KAIZEN PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:NIELSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:801-663-4092
Mailing Address - Street 1:5102 DURHAM CHAPEL HILL BLVD STE 214
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-3394
Mailing Address - Country:US
Mailing Address - Phone:919-617-6134
Mailing Address - Fax:
Practice Address - Street 1:5102 DURHAM CHAPEL HILL BLVD STE 214
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-3394
Practice Address - Country:US
Practice Address - Phone:919-617-6134
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-06
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy