Healthcare Provider Details

I. General information

NPI: 1639491558
Provider Name (Legal Business Name): ACORN PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2010
Last Update Date: 02/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2075 HIGHWAY 4
ARNOLD CA
95223
US

IV. Provider business mailing address

PO BOX 2834
ARNOLD CA
95223-2834
US

V. Phone/Fax

Practice location:
  • Phone: 209-795-3588
  • Fax: 209-795-6785
Mailing address:
  • Phone: 209-795-3588
  • Fax: 209-795-6785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT9740
License Number StateCA

VIII. Authorized Official

Name: MR. MICHAEL R. LEE
Title or Position: ADMINISTRATOR
Credential:
Phone: 209-795-3588