Healthcare Provider Details

I. General information

NPI: 1487613139
Provider Name (Legal Business Name): COMPREHENSIVE ORTHOPEDIC REHABILITATION AND EXERCISE PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 12/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3106 PONTE MORINO DRIVE SUITE A
CAMERON PARK CA
95682
US

IV. Provider business mailing address

3106 PONTE MORINO DR SUITE A
CAMERON PARK CA
95682-8277
US

V. Phone/Fax

Practice location:
  • Phone: 530-677-7565
  • Fax: 530-677-7683
Mailing address:
  • Phone: 530-677-7565
  • Fax: 530-677-7683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number27706
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. THOMAS CLIFTON CURRY JR.
Title or Position: PRESIDENT
Credential: P.T.
Phone: 530-677-7565