=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164711339
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVANCED SPINAL REHABILITATION, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2011
-----------------------------------------------------
Last Update Date | 06/17/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 845 TWELVE BRIDGES DR STE 140
-----------------------------------------------------
City | LINCOLN
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95648-8815
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-209-3484
-----------------------------------------------------
Fax | 916-209-3486
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1585 BUTTE HOUSE RD STE A
-----------------------------------------------------
City | YUBA CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95993-2200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-751-9340
-----------------------------------------------------
Fax | 530-673-0151
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JANICE IRENE GIES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 916-209-3484
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------