Provider Demographics
NPI:1659898559
Name:MK PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:MK PHYSICAL THERAPY INC
Other - Org Name:PHYSIO 2 GO
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER / PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:BENJAMIN
Authorized Official - Last Name:KRETCHEK
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:877-827-8246
Mailing Address - Street 1:4295 GESNER ST STE 3C1
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-6663
Mailing Address - Country:US
Mailing Address - Phone:877-827-8246
Mailing Address - Fax:
Practice Address - Street 1:4295 GESNER ST STE 3C1
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-6663
Practice Address - Country:US
Practice Address - Phone:877-827-8246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-23
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Single Specialty