Healthcare Provider Details

I. General information

NPI: 1467703587
Provider Name (Legal Business Name): CALIFORNIA PHYSICAL, OCCUPATIONAL, SPEECH & HAND THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2012
Last Update Date: 01/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1539 MCHENRY AVE
MODESTO CA
95350-4528
US

IV. Provider business mailing address

1539 MCHENRY AVE
MODESTO CA
95350-4528
US

V. Phone/Fax

Practice location:
  • Phone: 209-578-3290
  • Fax: 209-529-8643
Mailing address:
  • Phone: 209-578-3290
  • Fax: 209-529-8643

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 Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFF STECKLER
Title or Position: OWNER
Credential:
Phone: 209-578-3290