Provider Demographics
NPI:1467236661
Name:OUTDOOR FIT PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:OUTDOOR FIT PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:KENDALL
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:408-425-4448
Mailing Address - Street 1:1730 S AMPHLETT BLVD STE 116
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-2709
Mailing Address - Country:US
Mailing Address - Phone:650-550-1482
Mailing Address - Fax:
Practice Address - Street 1:1730 S AMPHLETT BLVD STE 116
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-2709
Practice Address - Country:US
Practice Address - Phone:650-550-1482
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-21
Last Update Date:2024-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy