KODA PHYSICAL THERAPY AND SPORTS PERFORMANCE (NPI# 1356797542) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356797542 |
| Entity Type | Organization |
| Organization Name | KODA PHYSICAL THERAPY AND SPORTS PERFORMANCE |
| Practice Address |
1600 Corporate Cir Petaluma CA 94954-6912 |
| Mailing Address |
Po Box 4971 Petaluma CA 94955-4971 |
| Practice Telephone | 7079818604 |
| Practice Fax Number | 7079818647 |
| Mailing Telephone | 7079818604 |
| Mailing Fax Number | 7079818647 |
| Enumeration Date | 2016-05-06 |
| Last Update Date | 2017-04-26 |
| Authorized Official Name | MR. LOREN K KIMBLE (OWNER) |
| Authorized Official Telephone | 4154255206 |
| Authorized Official Credential | PT, DPT |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2000X |
Clinic/Center Specialization: Physical Therapy |
Ambulatory Health Care Facilities |
| Street Address |
1600 CORPORATE CIR |
| City | PETALUMA |
| State | CA |
| Zip Code | 94954-6912 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336473362 | Loren Koda Kimble | Physical Therapist | 1600 Corporate Cir, Petaluma, CA 94954-6912 | 2009-09-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346883840 | Miguel Ibarra | Counselor | 5350 Old Redwood Highway, Petaluma, CA 94954 | 2019-10-28 |
| 1073169223 | Monica Renee Najera | Behavior Technician | 1670 Corporate Circle, Ste. 100, Petaluma, CA 94954 | 2019-08-14 |
| 1326607201 | Making Magic Happen - People Helping People, Inc. | Marriage & Family Therapist | 1318 Redwood Way, Suite 260, Petaluma, CA 94954 | 2019-06-13 |
| 1477019917 | Rubi Isela Cruz Mendoza I | Behavioral Analyst | 8 Round Walk Circle, Petaluma, CA 94954 | 2019-02-20 |
| 1932679511 | Karen Christianson | Behavior Technician | 1670 Corporate Circle Suite 100, Petaluma, CA 94954 | 2018-11-27 |
| 1669956967 | Alyssa Messer | Assistant Behavior Analyst | 1670 Corporate Cir, Petaluma, CA 94954 | 2018-09-21 |
| 1235620592 | Mallory Paige Mullikin | Nurse Practitioner | 141 Lynch Creek Trail, Ste C, Petaluma, CA 94954 | 2018-05-22 |
| 1457723710 | Lisabel Dolne | Counselor | 1360 N. Mcdowell Blvd.1a, Petaluma, CA 94954 | 2015-10-27 |
| 1083080717 | Pacific Restorative Center | Clinic/Center | 1456 Professional Drive, Suite 404, Petaluma, CA 94954 | 2015-08-17 |
| 1619354198 | Accu Quest Hearing Centers | Clinic/Center | 1456 Professional Dr., Suite 404, Petaluma, CA 94954 | 2015-05-04 |
| Find all providers in zip 94954 | ||||
| Taxonomy Code | 261QP2000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Physical Therapy |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013337161 | The Bernstein Institute for Trauma Treatment | Clinic/Center | 501 2nd St, Petaluma, CA 94952-5121 | 2014-04-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467051839 | The Pelvic Model Physical Therapy, Inc. | Clinic/Center | 3761 Vinton Ave Apt 6, Los Angeles, CA 90034-5781 | 2020-10-18 |
| 1932707957 | Body In Motion Therapy, P.c | Clinic/Center | 1111 S Grand Ave Apt 708, Los Angeles, CA 90015-2169 | 2020-10-12 |
| 1992303275 | Vw Physical Therapy, Inc. | Clinic/Center | 100 Saybrook Ave, Vacaville, CA 95687-4129 | 2020-10-09 |
| 1730787094 | Movement System Institute Physiotherapy Inc | Clinic/Center | 508 Glenwood Rd Apt 102, Glendale, CA 91202-1572 | 2020-10-09 |
| 1538766530 | Sterling King Physical Therapy | Clinic/Center | 1820 Fullerton Ave Ste 280, Corona, CA 92881-3175 | 2020-10-03 |
| 1902403041 | Jha Geriatric Services, Inc | Clinic/Center | 12490 Fielding Circle, Suite 174, Playa Vista, CA 90094-3024 | 2020-10-01 |
| 1245847540 | Bespoke San Diego Physical Therapy PC | Clinic/Center | 2748 Ariane Dr, Unit 141, San Diego, CA 92117-3407 | 2020-09-30 |
| 1285241786 | Rapid Recovery Physical Therapy Inc | Clinic/Center | 39807 Paseo Padre Pkwy, Fremont, CA 94538-2974 | 2020-09-28 |
| 1053928697 | Bonnie Laine Lasher | Clinic/Center | 33772 Copper Lantern St Apt C, Dana Point, CA 92629-6427 | 2020-09-28 |
| 1295340792 | Naum Physical Therapy PC | Clinic/Center | 11405 Fulbourn Ct, Rancho Cucamonga, CA 91730-8341 | 2020-09-10 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.