Provider Demographics
NPI:1316278732
Name:KISHI, CAROLE (PT)
Entity type:Individual
Prefix:
First Name:CAROLE
Middle Name:
Last Name:KISHI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 S RAYMOND AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-7100
Mailing Address - Country:US
Mailing Address - Phone:626-576-0591
Mailing Address - Fax:626-576-5890
Practice Address - Street 1:55 S RAYMOND AVE
Practice Address - Street 2:STE 100
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-7100
Practice Address - Country:US
Practice Address - Phone:626-576-0591
Practice Address - Fax:626-576-5890
Is Sole Proprietor?:No
Enumeration Date:2010-01-25
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 35221225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT 35221OtherPHYSICAL THERAPY BOARD OF CALIFORNIA