Provider Demographics
NPI:1710912126
Name:KRPATA, CHARLES E (PT)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:E
Last Name:KRPATA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT5548225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ57749ZOtherBLUE SHIELD GROUP NUMBER
CAS66290Medicare UPIN
CAZZZ15703ZMedicare ID - Type UnspecifiedGROUP NUMBER