Healthcare Provider Details

I. General information

NPI: 1669576930
Provider Name (Legal Business Name): ALPINE PHYSICAL THERAPY & WELLNESS CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2006
Last Update Date: 01/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2549 ALPINE BLVD
ALPINE CA
91901-3950
US

IV. Provider business mailing address

2549 ALPINE BLVD
ALPINE CA
91901-3950
US

V. Phone/Fax

Practice location:
  • Phone: 619-445-3168
  • Fax: 619-445-5368
Mailing address:
  • Phone: 619-445-3168
  • Fax: 619-445-5368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MATTHEW DANIEL KRAEMER
Title or Position: PRESIDENT
Credential: PT NCS
Phone: 619-445-3168