Healthcare Provider Details

I. General information

NPI: 1003021601
Provider Name (Legal Business Name): SCOTT VALLEY PHYSICAL THERAPY AND FITNESS CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 05/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 SCOTT RIVER RD
FORT JONES CA
96032-9620
US

IV. Provider business mailing address

PO BOX 217
FORT JONES CA
96032-0217
US

V. Phone/Fax

Practice location:
  • Phone: 530-468-5528
  • Fax:
Mailing address:
  • Phone: 530-468-5528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DOUGLAS SCOTT KORCEK
Title or Position: CEO
Credential: P. T.
Phone: 530-468-5528