Individual
MITCHELL KAUK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT OCS
Contact information
Practice address
224A WELLER ST, PETALUMA, CA 94952-3136
(707) 762-7678
(707) 762-7679
Mailing address
224A WELLER ST, PETALUMA, CA 94952-3136
(707) 762-7678
(707) 762-7679
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
PT10959
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
093769
HEALTHNET PROVIDER ID
CA
01
—
677476
ACN/BLUE SHIELD PROVIDER
CA
05
—
PT0109590
—
CA
Enumeration date
10/26/2006
Last updated
05/16/2013
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