Healthcare Provider Details

I. General information

NPI: 1619398062
Provider Name (Legal Business Name): ORTHOPEDIC PHYSICAL THERAPY INSTITUTE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/01/2014
Last Update Date: 03/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4028 DALE RD SUITE 101
MODESTO CA
95356-9561
US

IV. Provider business mailing address

4028 DALE RD SUITE 101
MODESTO CA
95356-9561
US

V. Phone/Fax

Practice location:
  • Phone: 209-312-9739
  • Fax: 209-312-9747
Mailing address:
  • Phone: 209-312-9739
  • Fax: 209-312-9747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT35400
License Number StateCA

VIII. Authorized Official

Name: DR. TRAVIS BARTELINK
Title or Position: CEO
Credential: DPT
Phone: 209-312-9739