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General NPI Number Information
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NPI Number | 1043363542
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Entity Type | Organization
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Legal Business Name | SANDS TRAVELER PT, INC.
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 09/03/2009
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Provider Practice Location Address
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Address Line | 76 CRESENT
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City | QUINCY
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State | CA
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Zip | 95971
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Country | US
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Telephone | 530-283-0313
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Fax |
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Provider Business Mailing Address
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Address Line | 72795 S DELLEKER
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City | PORTOLA
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State | CA
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Zip | 96122
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Country | US
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Telephone | 530-283-0313
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. REYNALDO PESINA
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Credential | PT
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Telephone | 530-283-0313
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | PT17342
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License Number State | CA
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