Healthcare Provider Details

I. General information

NPI: 1710543327
Provider Name (Legal Business Name): MADELINE KHORSHIDCHEHR DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MADELINE MCCALIB

II. Dates (important events)

Enumeration Date: 05/20/2019
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

990 RILEY ST
FOLSOM CA
95630-3064
US

IV. Provider business mailing address

990 RILEY ST
FOLSOM CA
95630-3064
US

V. Phone/Fax

Practice location:
  • Phone: 916-355-1250
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number77960
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number308220
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: