Healthcare Provider Details

I. General information

NPI: 1689405029
Provider Name (Legal Business Name): BIOSPORT PHYSICAL THERAPY TURLOCK INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2024
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 W MONTE VISTA AVE
TURLOCK CA
95382-9663
US

IV. Provider business mailing address

PO BOX 576751
MODESTO CA
95357-6751
US

V. Phone/Fax

Practice location:
  • Phone: 209-524-7488
  • Fax: 209-522-7488
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
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SEAN FJELLSTROM
Title or Position: OWNER
Credential: DPT
Phone: 209-581-7944