Active NPI
Kaylin Jaie Mordock, P.T.
- Physical Therapist
- San Rafael, CA
National Provider Identifier
1386626505
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT24020
- Practice address
- 205A Marin St
San Rafael, CA 94901-3713 - Phone
- (415) 336-1358
- NPI assigned
- Nov 15, 2005
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT24020 | CA | Primary |
Addresses
Primary practice location
205A Marin St
San Rafael, CA 94901-3713
Mailing address
5 Bon Air Rd
Ste 129
Larkspur, CA 94939-1139
Phone (415) 336-1358
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT24020 | CA | MD | Physical Therapist |
| 24020 | CA | MD | Student in an Organized Health Care Education/Training Program |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1132012800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1466726400000",
"number": "1386626505",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5 BON AIR RD",
"address_2": "STE 129",
"city": "LARKSPUR",
"state": "CA",
"postal_code": "949391139",
"telephone_number": "415-336-1358"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "205A MARIN ST",
"city": "SAN RAFAEL",
"state": "CA",
"postal_code": "949013713",
"telephone_number": "415-336-1358"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MORDOCK",
"first_name": "KAYLIN",
"middle_name": "JAIE",
"name_prefix": "Mrs.",
"credential": "P.T.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2005-11-15",
"last_updated": "2016-06-24",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "PT24020",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Rafael, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.