Healthcare Provider Details

I. General information

NPI: 1003563149
Provider Name (Legal Business Name): PIVOTAL CONNECTIONS PHYSICAL THERAPY P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2022
Last Update Date: 04/11/2022
Certification Date: 04/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 G ST STE E
ARCATA CA
95521-6694
US

IV. Provider business mailing address

1913 SAGEWOOD WAY
MCKINLEYVILLE CA
95519-3683
US

V. Phone/Fax

Practice location:
  • Phone: 707-702-2241
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: MICHELE BENSON
Title or Position: OFFICE MANAGER
Credential:
Phone: 707-702-2241