Provider Demographics
NPI:1477524635
Name:KANE, EDWARD J (PT,PHD,ATC,ECS,SCS)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:J
Last Name:KANE
Suffix:
Gender:M
Credentials:PT,PHD,ATC,ECS,SCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 WINDY POINT DR
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92069-1701
Mailing Address - Country:US
Mailing Address - Phone:760-591-3012
Mailing Address - Fax:760-591-3053
Practice Address - Street 1:700 WINDY POINT DR
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069-1701
Practice Address - Country:US
Practice Address - Phone:760-591-3012
Practice Address - Fax:760-591-3053
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11437225100000X
CA412251E1300X
2251S0007X, 2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251E1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistElectrophysiology, Clinical
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer