Healthcare Provider Details
I. General information
NPI: 1235165515
Provider Name (Legal Business Name): WESTERN PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 06/25/2006
Last Update Date: 08/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
9341 MIDWAY SUITE C
DURHAM CA
95938-9785
US
IV. Provider business mailing address
PO BOX 493396
REDDING CA
96049-3396
US
V. Phone/Fax
- Phone: 530-343-2010
- Fax: 530-343-2012
- Phone: 530-221-9952
- Fax: 530-221-9954
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 225100000X |
| Taxonomy | Physical Therapist |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
DONALD
ROY
BAAS
Title or Position: CO-OWNER PHYSICAL THERAPIST
Credential: P.T.
Phone: 530-221-9952