Provider Demographics
NPI:1295301893
Name:KIDS PHYSICAL THERAPY ZONE INC
Entity type:Organization
Organization Name:KIDS PHYSICAL THERAPY ZONE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEIKO
Authorized Official - Middle Name:
Authorized Official - Last Name:GOJI
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:805-843-1083
Mailing Address - Street 1:397 MOBIL AVE
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-6310
Mailing Address - Country:US
Mailing Address - Phone:805-383-1501
Mailing Address - Fax:805-384-0478
Practice Address - Street 1:397 MOBIL AVE
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-6310
Practice Address - Country:US
Practice Address - Phone:805-383-1501
Practice Address - Fax:805-384-0478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-03
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty