Healthcare Provider Details

I. General information

NPI: 1417885815
Provider Name (Legal Business Name): COLUSA INDIAN COMMUNITY COUNCIL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 MARKET ST STE B
COLUSA CA
95932-2455
US

IV. Provider business mailing address

640 MARKET ST STE B
COLUSA CA
95932-2455
US

V. Phone/Fax

Practice location:
  • Phone: 530-458-6608
  • Fax:
Mailing address:
  • Phone: 530-458-6608
  • 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: CATRINA MARIE ROSS
Title or Position: DIRECTOR OF CLINIC OPERATIONS
Credential:
Phone: 530-458-6542