Provider Demographics
NPI:1023712932
Name:PASSAGE PHYSICAL THERAPY AND WELLNESS PC
Entity type:Organization
Organization Name:PASSAGE PHYSICAL THERAPY AND WELLNESS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KAYLA
Authorized Official - Middle Name:KIMBERLY
Authorized Official - Last Name:FROST
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, PT
Authorized Official - Phone:760-828-2492
Mailing Address - Street 1:139 AVENIDA ESPERANZA UNIT 2
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-4308
Mailing Address - Country:US
Mailing Address - Phone:760-828-2492
Mailing Address - Fax:
Practice Address - Street 1:139 AVENIDA ESPERANZA UNIT 2
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-4308
Practice Address - Country:US
Practice Address - Phone:760-828-2492
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy