Healthcare Provider Details

I. General information

NPI: 1871610287
Provider Name (Legal Business Name): EAST SACRAMENTO PHYSICAL THERAPY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 08/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5260 ELVAS AVE
SACRAMENTO CA
95819-2332
US

IV. Provider business mailing address

5260 ELVAS AVE
SACRAMENTO CA
95819-2332
US

V. Phone/Fax

Practice location:
  • Phone: 916-457-8802
  • Fax:
Mailing address:
  • Phone: 916-457-8802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT92590
License Number StateCA

VIII. Authorized Official

Name: DR. RISA MACDONALD
Title or Position: OWNER
Credential: PT, DPT
Phone: 916-457-8802