Healthcare Provider Details

I. General information

NPI: 1124000682
Provider Name (Legal Business Name): CALIFORNIA SPORTS PHYSICAL THERAPY CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 01/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2230 GLADSTONE DR
PITTSBURG CA
94565-5121
US

IV. Provider business mailing address

2000 GARDEN RD
MONTEREY CA
93940-5313
US

V. Phone/Fax

Practice location:
  • Phone: 925-427-5155
  • Fax: 925-427-9552
Mailing address:
  • Phone: 831-375-1885
  • Fax: 831-375-7436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 26479
License Number StateCA

VIII. Authorized Official

Name: MR. JONATHAN DOCKERY
Title or Position: VICE PRESIDENT OF REVENUE CYCLE
Credential:
Phone: 760-602-4105