Provider Demographics
NPI:1881650505
Name:KIMBERLY GLADFELTER
Entity Type:Organization
Organization Name:KIMBERLY GLADFELTER
Other - Org Name:PHYSIOFIT PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:GLADFELTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-947-8500
Mailing Address - Street 1:1000 FREMONT AVE
Mailing Address - Street 2:STE 108
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94024-6093
Mailing Address - Country:US
Mailing Address - Phone:650-947-8500
Mailing Address - Fax:650-947-8501
Practice Address - Street 1:1000 FREMONT AVE
Practice Address - Street 2:STE. 108
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94024-6093
Practice Address - Country:US
Practice Address - Phone:650-947-8500
Practice Address - Fax:650-947-8501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ24631ZMedicare ID - Type Unspecified