Healthcare Provider Details

I. General information

NPI: 1992787477
Provider Name (Legal Business Name): CAMPUS COMMONS PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 11/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 UNIVERSITY AVE STE 185
SACRAMENTO CA
95825-6739
US

IV. Provider business mailing address

601 UNIVERSITY AVE STE 185
SACRAMENTO CA
95825-6739
US

V. Phone/Fax

Practice location:
  • Phone: 916-927-1333
  • Fax: 916-927-1586
Mailing address:
  • Phone: 916-927-1333
  • Fax: 916-927-1586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MARK D EDDY
Title or Position: OWNER
Credential: P.T.
Phone: 916-927-1333