Provider Demographics
NPI:1184612541
Name:FELKER, KORY PAUL (MPT)
Entity type:Individual
Prefix:MR
First Name:KORY
Middle Name:PAUL
Last Name:FELKER
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 E CENTRAL AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:QUINCY
Mailing Address - State:CA
Mailing Address - Zip Code:95971-9718
Mailing Address - Country:US
Mailing Address - Phone:530-283-2202
Mailing Address - Fax:530-283-2204
Practice Address - Street 1:78 E CENTRAL AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:QUINCY
Practice Address - State:CA
Practice Address - Zip Code:95971-9718
Practice Address - Country:US
Practice Address - Phone:530-283-2202
Practice Address - Fax:530-283-2204
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-10
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT8023225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA30-0335817OtherTAX I.D. NUMBER
CAPT 28023OtherPHYSICAL THERAPY LICENSE