Active NPI
Kevin G Kanzelman, PT
- Physical Therapist
- Rancho Cucamonga, CA
National Provider Identifier
1922124809
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 0781
- Practice address
- 9190 Haven Ave
Suite 100 & 240
Rancho Cucamonga, CA 91730-5431 - Phone
- (909) 484-3801
- Fax
- (866) 893-1444
- NPI assigned
- Mar 22, 2007
- Sex
- Male
- Sole proprietor
- No
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 | 0781 | CA | Primary |
Addresses
Primary practice location
9190 Haven Ave
Suite 100 & 240
Rancho Cucamonga, CA 91730-5431
Mailing address
9107 Wine Cellar Ave
Las Vegas, NV 89148-4910
Phone (702) 985-4325
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0781 | CA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174521600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1922124809",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9107 WINE CELLAR AVE",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891484910",
"telephone_number": "702-985-4325",
"fax_number": "866-893-1444"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9190 HAVEN AVE",
"address_2": "SUITE 100 & 240",
"city": "RANCHO CUCAMONGA",
"state": "CA",
"postal_code": "917305431",
"telephone_number": "909-484-3801",
"fax_number": "866-893-1444"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KANZELMAN",
"first_name": "KEVIN",
"middle_name": "G",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "0781",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rancho Cucamonga, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.