Healthcare Provider Details

I. General information

NPI: 1578531398
Provider Name (Legal Business Name): ATHLETIC & INDUSTRIAL REHABILITATN PHYSICAL THERAPY INC A PROF CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 03/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2116 E ORANGEBURG AVE
MODESTO CA
95355-3370
US

IV. Provider business mailing address

450 GLASS LN STE C
MODESTO CA
95356-9287
US

V. Phone/Fax

Practice location:
  • Phone: 209-529-1709
  • Fax: 209-572-2841
Mailing address:
  • Phone: 209-342-2300
  • Fax: 209-524-4240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT8536
License Number StateCA

VIII. Authorized Official

Name: DOUGLAS C CLAUSSEN
Title or Position: PRES OF CORP
Credential: DPT
Phone: 209-529-1709