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General NPI Number Information
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NPI Number | 1346510310
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Entity Type | Organization
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Legal Business Name | MOUNTAIN PHYSICAL THERAPY
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Dates
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Enumeration Date | 01/09/2012
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Last Update Date | 01/09/2012
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Provider Practice Location Address
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Address Line | 20 CRESCENT ST B
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City | QUINCY
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State | CA
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Zip | 95971-9118
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Country | US
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Telephone | 530-283-2291
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Fax | 530-283-2292
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Provider Business Mailing Address
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Address Line | 20 CRESCENT ST B
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City | QUINCY
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State | CA
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Zip | 95971-9118
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Country | US
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Telephone | 530-283-2291
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Fax | 530-283-2292
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST
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Name | JOAQUIN A VARGAS
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Credential | PT
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Telephone | 530-249-1520
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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 | PT6440
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License Number State | CA
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