Healthcare Provider Details

I. General information

NPI: 1710670906
Provider Name (Legal Business Name): BIOSPORT PHYSICAL THERAPY TRACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2023
Last Update Date: 06/01/2023
Certification Date: 06/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2156 W GRANT LINE RD STE 215
TRACY CA
95377-7337
US

IV. Provider business mailing address

PO BOX 576751
MODESTO CA
95357-6751
US

V. Phone/Fax

Practice location:
  • Phone: 209-318-0282
  • Fax: 209-318-0283
Mailing address:
  • Phone: 209-524-7488
  • Fax: 209-522-7488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. KARANDEEP GILL
Title or Position: OWNER / PHYSICAL THERAPIST
Credential: DPT
Phone: 209-627-6670