Healthcare Provider Details

I. General information

NPI: 1497788202
Provider Name (Legal Business Name): FOLSOM PHYSICAL THERAPY AND TRAINING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 12/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 NATOMA ST
FOLSOM CA
95630-2615
US

IV. Provider business mailing address

115 NATOMA ST
FOLSOM CA
95630-2615
US

V. Phone/Fax

Practice location:
  • Phone: 916-355-8500
  • Fax: 916-355-8196
Mailing address:
  • Phone: 916-355-8500
  • Fax: 916-355-8196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number0603009
License Number StateCA

VIII. Authorized Official

Name: MR. TIMOTHY EUGENE MCGONIGLE
Title or Position: PHYSICAL THERAPIST, CO-OWNER
Credential: P.T.
Phone: 916-355-8500