Provider Demographics
NPI:1366931669
Name:CANTERBURY, KIM (PT)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:CANTERBURY
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 1:4352 ARBOR COVE CIR
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92058-6954
Mailing Address - Country:US
Mailing Address - Phone:760-815-0541
Mailing Address - Fax:
Practice Address - Street 1:4352 ARBOR COVE CIR
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92058-6954
Practice Address - Country:US
Practice Address - Phone:760-579-2868
Practice Address - Fax:760-547-1676
Is Sole Proprietor?:No
Enumeration Date:2018-05-02
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT22343225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist