MEDICARE: VALLEY SPRINGS PHYSICAL THERAPY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1043516560	OTHER	CA	SOLE PROPRIETORS NPI

General Provider Information

NPI Number	:	1518924604
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALLEY SPRINGS PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	10B VISTA DEL LAGO DR
Second Line	:
City	:	VALLEY SPRINGS
State	:	CA
Zip	:	95252-8796
Country	:	US
Telephone Number	:	209-772-0848
Fax Number	:	209-772-8533

Provider Business Practice Location Address
First Line	:	10B VISTA DEL LAGO DR
Second Line	:
City	:	VALLEY SPRINGS
State	:	CA
Zip	:	95252-8796
Country	:	US
Telephone Number	:	209-772-0848
Fax Number	:	209-772-8533

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. MARLINE L JUAREZ
Credential	:
Telephone Number	:	209-772-0898

Provider Enumeration Date	:	05/01/2006
Last Update Date	:	11/28/2012

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