Healthcare Provider Details

I. General information

NPI: 1518924604
Provider Name (Legal Business Name): VALLEY SPRINGS PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 11/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10B VISTA DEL LAGO DR
VALLEY SPRINGS CA
95252-8796
US

IV. Provider business mailing address

10B VISTA DEL LAGO DR
VALLEY SPRINGS CA
95252-8796
US

V. Phone/Fax

Practice location:
  • Phone: 209-772-0848
  • Fax: 209-772-8533
Mailing address:
  • Phone: 209-772-0848
  • Fax: 209-772-8533

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: MRS. MARLINE L JUAREZ
Title or Position: OFFICE MANAGER
Credential:
Phone: 209-772-0898