Provider Demographics
NPI:1871669622
Name:GOLDFARB, KAHL (DPT, DMT)
Entity Type:Individual
Prefix:
First Name:KAHL
Middle Name:
Last Name:GOLDFARB
Suffix:
Gender:F
Credentials:DPT, DMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3639 MIDWAY DR STE B286
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-5254
Mailing Address - Country:US
Mailing Address - Phone:858-488-3597
Mailing Address - Fax:858-488-3178
Practice Address - Street 1:3115 OCEAN FRONT WALK
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-8729
Practice Address - Country:US
Practice Address - Phone:858-488-3597
Practice Address - Fax:858-488-3178
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT23900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT23900AMedicare UPIN
CAW17206Medicare ID - Type UnspecifiedBUSINESS ID