Organization
KING CITY PHYSICAL THERAPY APC
Active
Other names
SUMMIT PHYSICAL THERAPY
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DEBBIE L ESTRADA (BILLING MANAGER)
(805) 227-4156
Entity
Organization
Contact information
Practice address
200 BROADWAY ST, STE 28, KING CITY, CA 93930-2865
(831) 386-9710
Mailing address
200 BROADWAY ST, STE 28, KING CITY, CA 93930-2865
(831) 386-9710
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
PT06391
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GPT001411
—
CA
01
—
PT6391
BLUE CROSS OF CALIF
CA
01
—
ZZZ06333Z
BLUE SHIELD OF CALIF
CA
Enumeration date
12/06/2006
Last updated
06/03/2008
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