Provider Demographics
NPI:1578582763
Name:KRPATA SPORTS THERAPY, INC.
Entity Type:Organization
Organization Name:KRPATA SPORTS THERAPY, INC.
Other - Org Name:ADVANCED ORTHOPEDIC AND SPORTS THERAPY PHYSICAL THERAPY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:KRPATA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:831-622-0599
Mailing Address - Street 1:26617 CARMEL CENTER PL
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:CA
Mailing Address - Zip Code:93923-8655
Mailing Address - Country:US
Mailing Address - Phone:831-622-0599
Mailing Address - Fax:831-622-7599
Practice Address - Street 1:26617 CARMEL CENTER PL
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:CA
Practice Address - Zip Code:93923-8655
Practice Address - Country:US
Practice Address - Phone:831-622-0599
Practice Address - Fax:831-622-7599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ05732ZOtherBLUE SHIELD GROUP NUMBER
CAZZZ15703ZMedicare ID - Type Unspecified