Healthcare Provider Details

I. General information

NPI: 1588741573
Provider Name (Legal Business Name): ELLER PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 CEANOTHUS AVE.
CHICO CA
95973
US

IV. Provider business mailing address

PO BOX 990955
REDDING CA
96099-0955
US

V. Phone/Fax

Practice location:
  • Phone: 530-892-2810
  • Fax: 530-892-2647
Mailing address:
  • Phone: 530-243-2164
  • Fax: 530-243-9446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT 22065
License Number StateCA

VIII. Authorized Official

Name: MR. MATT ELLER
Title or Position: OWNER
Credential: MPT, ATC, MTC
Phone: 530-892-2810