=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043084635
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GRIT PERFORMANCE PHYSICAL THERAPY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2023
-----------------------------------------------------
Last Update Date | 08/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10398 ROCKINGHAM DR STE 9
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95827-2507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-693-1837
-----------------------------------------------------
Fax | 916-720-0112
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12201 ENCANTO WAY
-----------------------------------------------------
City | RANCHO CORDOVA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95742-6791
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-693-1837
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DUSTIN LEA HARRIS
-----------------------------------------------------
Credential | DPT, ATC
-----------------------------------------------------
Telephone | 916-693-1837
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------