Provider Demographics
NPI:1689219594
Name:KODA THERAPY GROUP
Entity Type:Organization
Organization Name:KODA THERAPY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:ABIGAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWE
Authorized Official - Suffix:
Authorized Official - Credentials:CMT
Authorized Official - Phone:650-441-2894
Mailing Address - Street 1:2421 PARK BLVD STE B205
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-1998
Mailing Address - Country:US
Mailing Address - Phone:650-441-2894
Mailing Address - Fax:
Practice Address - Street 1:2421 PARK BLVD STE B205
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-1998
Practice Address - Country:US
Practice Address - Phone:650-441-2894
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-14
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1831751403OtherPROFESSIONAL