Basic Information
| Provider Information | |||||||||
| NPI: | 1720395585 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RAFFETY | ||||||||
| FirstName: | KIMIKA | ||||||||
| MiddleName: | ZIADIE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2600 STANWELL DR | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | CONCORD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945204862 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9256865400 | ||||||||
| FaxNumber: | 2149051323 | ||||||||
| Practice Location | |||||||||
| Address1: | 2600 STANWELL DR | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | CONCORD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945204862 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9256865400 | ||||||||
| FaxNumber: | 9256863709 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2010 | ||||||||
| LastUpdateDate: | 03/17/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1145282 | TX | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 174400000X | 41315 | CA | Y | Other Service Providers | Specialist |
No ID Information.