Healthcare Provider Details

I. General information

NPI: 1053490011
Provider Name (Legal Business Name): COOL PHYSICAL THERAPY AND SPEECH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 07/06/2021
Certification Date: 07/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 ELLINGHOUSE DR STE 100
COOL CA
95614-9568
US

IV. Provider business mailing address

5000 ELLINGHOUSE DR STE 100
COOL CA
95614-9568
US

V. Phone/Fax

Practice location:
  • Phone: 530-887-9598
  • Fax: 530-887-9512
Mailing address:
  • Phone: 530-887-9598
  • Fax: 530-887-9512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 26148
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number13073
License Number StateCA

VIII. Authorized Official

Name: MR. JAMES CLAYTON KREUTZ
Title or Position: MPT
Credential:
Phone: 530-887-9598