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General NPI Number Information
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NPI Number | 1528147907
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Entity Type | Organization
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Legal Business Name | SPORTS MEDICINE AND REHAB THERAPY, INC.
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Dates
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Enumeration Date | 11/04/2006
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Last Update Date | 02/09/2009
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Provider Practice Location Address
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Address Line | 152 PIONEER LN SUITE D
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City | BISHOP
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State | CA
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Zip | 93514-2563
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Country | US
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Telephone | 760-873-8220
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Fax | 760-873-4443
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Provider Business Mailing Address
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Address Line | 152 PIONEER LN SUITE D
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City | BISHOP
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State | CA
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Zip | 93514-2563
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Country | US
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Telephone | 760-873-8220
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Fax | 760-873-4443
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. PATRICIA L. GARDNER
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Credential | P.T.
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Telephone | 760-873-8220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 0PT253460
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 00PT78460
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License Number State | CA
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