Healthcare Provider Details

I. General information

NPI: 1760923874
Provider Name (Legal Business Name): RICHARD WURSTER P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: RICHARD WURSTER P.T.

II. Dates (important events)

Enumeration Date: 03/09/2017
Last Update Date: 03/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 AINSDALE DR
ROSEVILLE CA
95747-5838
US

IV. Provider business mailing address

1640 AINSDALE DR
ROSEVILLE CA
95747-5838
US

V. Phone/Fax

Practice location:
  • Phone: 916-759-2000
  • Fax:
Mailing address:
  • Phone: 916-759-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberPT19666
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: