Provider Demographics
NPI:1861610917
Name:KAVAYIOTIDIS, JOHN (PT)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:KAVAYIOTIDIS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:MR
Other - First Name:JOHN
Other - Middle Name:
Other - Last Name:KAVAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:39201 STATE ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1437
Mailing Address - Country:US
Mailing Address - Phone:510-791-5521
Mailing Address - Fax:510-791-6380
Practice Address - Street 1:39201 STATE ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1437
Practice Address - Country:US
Practice Address - Phone:510-791-5521
Practice Address - Fax:510-791-6380
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA92500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT92500OtherPT NUMBER
CA00PT92500Medicare ID - Type UnspecifiedMEDICARE NUMBER