Healthcare Provider Details

I. General information

NPI: 1649255605
Provider Name (Legal Business Name): THER-A-CON PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2103 MYRTLE AVE
EUREKA CA
95501-3323
US

IV. Provider business mailing address

2103 MYRTLE AVE
EUREKA CA
95501-3323
US

V. Phone/Fax

Practice location:
  • Phone: 707-445-9150
  • Fax: 707-444-1372
Mailing address:
  • Phone: 707-445-9150
  • Fax: 707-444-1372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARTIE JOHANNA VAN WERKUM-GLIDDEN
Title or Position: PHYSICAL THERAPIST
Credential: PT
Phone: 707-445-9150