Provider Demographics
NPI:1558234344
Name:HYBRD PHYSICAL THERAPY & PERFORMANCE THEODORE KWONG
Entity type:Organization
Organization Name:HYBRD PHYSICAL THERAPY & PERFORMANCE THEODORE KWONG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:MR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:ALDEN
Authorized Official - Last Name:KWONG
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:669-300-9112
Mailing Address - Street 1:1173 SIERRA MADRES TER
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-5205
Mailing Address - Country:US
Mailing Address - Phone:669-300-9112
Mailing Address - Fax:
Practice Address - Street 1:1173 SIERRA MADRES TER
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-5205
Practice Address - Country:US
Practice Address - Phone:669-300-9112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-26
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy