Healthcare Provider Details

I. General information

NPI: 1336407139
Provider Name (Legal Business Name): NORTH AREA PHYSICAL THERAPY AND AQUATIC THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2012
Last Update Date: 09/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4737 EL CAMINO AVE
CARMICHAEL CA
95608-4938
US

IV. Provider business mailing address

4737 EL CAMINO AVE
CARMICHAEL CA
95608-4938
US

V. Phone/Fax

Practice location:
  • Phone: 916-487-3473
  • Fax:
Mailing address:
  • Phone: 916-487-3473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number43202
License Number StateCA

VIII. Authorized Official

Name: MR. ALEXANDER RAY
Title or Position: OWNER/ PHYSICAL THERAPIST
Credential: P.T.
Phone: 916-616-2179