Healthcare Provider Details

I. General information

NPI: 1235111741
Provider Name (Legal Business Name): CALIFORNIA SPORTS PHYSICAL THERAPY CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5910 PACIFIC AVE
STOCKTON CA
95207-4704
US

IV. Provider business mailing address

2600 DALLAS PKWY STE 290
FRISCO TX
75034-7493
US

V. Phone/Fax

Practice location:
  • Phone: 209-475-1000
  • Fax: 209-475-1809
Mailing address:
  • Phone: 945-260-0010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: ROBERT PACE
Title or Position: COO
Credential:
Phone: 213-804-1712