Healthcare Provider Details

I. General information

NPI: 1881123560
Provider Name (Legal Business Name): PAUL ROBERT DOUCOT DPT, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2017
Last Update Date: 07/21/2022
Certification Date: 11/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 ALHAMBRA BLVD STE 200
SACRAMENTO CA
95816-5241
US

IV. Provider business mailing address

1201 ALHAMBRA BLVD STE 200
SACRAMENTO CA
95816-5241
US

V. Phone/Fax

Practice location:
  • Phone: 916-731-7900
  • Fax: 916-731-7915
Mailing address:
  • Phone: 916-731-7900
  • Fax: 916-731-7915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: