Provider Demographics
NPI:1982395968
Name:PHYSIO KAI SPORTS PERFORMANCE & PHYSICAL THERAPY
Entity Type:Organization
Organization Name:PHYSIO KAI SPORTS PERFORMANCE & PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SOFIA
Authorized Official - Middle Name:NATALIA
Authorized Official - Last Name:VIZCARRA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:760-879-9716
Mailing Address - Street 1:2550 CANYON SPRINGS PKWY STE I
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-0951
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:951-261-5474
Practice Address - Street 1:1827 REDFIELD RD
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-7817
Practice Address - Country:US
Practice Address - Phone:760-879-9716
Practice Address - Fax:951-261-5474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty