Provider Demographics
NPI:1619334992
Name:MIKLA DUNNING PHYSICAL THERAPY SYSTEMS, PC
Entity Type:Organization
Organization Name:MIKLA DUNNING PHYSICAL THERAPY SYSTEMS, PC
Other - Org Name:KIME PERFORMANCE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:MIKLA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:916-342-4190
Mailing Address - Street 1:4990 HILLSDALE CIR
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-5770
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4990 HILLSDALE CIR
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-5770
Practice Address - Country:US
Practice Address - Phone:916-342-4190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-18
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29751261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy