Organization
KODA PHYSICAL THERAPY AND SPORTS PERFORMANCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LOREN K KIMBLE PT, DPT (OWNER)
(415) 425-5206
Entity
Organization
Contact information
Practice address
1600 CORPORATE CIR, PETALUMA, CA 94954-6912
(707) 981-8604
(707) 981-8647
Mailing address
1600 CORPORATE CIR, PETALUMA, CA 94954-6912
(707) 981-8604
(707) 981-8647
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
05/06/2016
Last updated
06/10/2021
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