Basic Information
| Provider Information | |||||||||
| NPI: | 1437730504 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KANSAS LUNA CARE PHYSICAL THERAPY LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2350 | ||||||||
| Address2: | |||||||||
| City: | ROCKLIN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956778350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6508670522 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6030 W OAKS BLVD STE 210 | ||||||||
| Address2: | |||||||||
| City: | ROCKLIN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 957655491 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8668063599 | ||||||||
| FaxNumber: | 8338177128 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2021 | ||||||||
| LastUpdateDate: | 04/19/2021 | ||||||||
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| AuthorizedOfficialLastName: | ODELL | ||||||||
| AuthorizedOfficialFirstName: | CLARISA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PAYER DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6508670522 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 04/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225100000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.