Healthcare Provider Details

I. General information

NPI: 1043084635
Provider Name (Legal Business Name): GRIT PERFORMANCE PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2023
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10398 ROCKINGHAM DR STE 9
SACRAMENTO CA
95827-2507
US

IV. Provider business mailing address

12201 ENCANTO WAY
RANCHO CORDOVA CA
95742-6791
US

V. Phone/Fax

Practice location:
  • Phone: 916-693-1837
  • Fax: 916-720-0112
Mailing address:
  • Phone: 916-693-1837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: DUSTIN LEA HARRIS
Title or Position: CEO
Credential: DPT, ATC
Phone: 916-693-1837