Healthcare Provider Details

I. General information

NPI: 1134859374
Provider Name (Legal Business Name): SHIFT PHYSICAL THERAPY & PERFORMANCE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2022
Last Update Date: 06/11/2022
Certification Date: 06/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 W LINE ST STE B
BISHOP CA
93514-3452
US

IV. Provider business mailing address

308 W LINE ST STE B
BISHOP CA
93514-3452
US

V. Phone/Fax

Practice location:
  • Phone: 760-914-4401
  • 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: ANDREA DILLON
Title or Position: CEO
Credential:
Phone: 989-860-8494