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General NPI Number Information
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NPI Number | 1578567020
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Entity Type | Organization
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Legal Business Name | VIBRANTCARE OUTPATIENT REHABILITATION OF CALIFORNIA, INC.
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Dates
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Enumeration Date | 06/10/2005
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Last Update Date | 09/18/2019
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Provider Practice Location Address
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Address Line | 937 COFFEE RD STE 900
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City | MODESTO
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State | CA
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Zip | 95355-4240
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Country | US
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Telephone | 209-496-9003
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Fax | 209-496-9004
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Provider Business Mailing Address
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Address Line | 2270 DOUGLAS BLVD STE 112
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City | ROSEVILLE
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State | CA
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Zip | 95661-3869
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Country | US
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Telephone | 916-782-1212
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Fax | 916-773-1481
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Authorized Official
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Title or Position | CEO
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Name | MR. DAVID SMITH
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Credential |
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Telephone | 916-782-1212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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