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General NPI Number Information
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NPI Number | 1609087287
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Entity Type | Organization
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Legal Business Name | SUSANVILLE THERAPY ATHLETIC REHABILITATION
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 711 MAIN ST
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City | SUSANVILLE
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State | CA
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Zip | 96130-4329
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Country | US
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Telephone | 530-257-8989
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Fax | 530-257-4649
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Provider Business Mailing Address
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Address Line | 711 MAIN ST
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City | SUSANVILLE
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State | CA
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Zip | 96130-4329
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Country | US
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Telephone | 530-257-8989
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Fax | 530-257-4649
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | NORMAN C HUBBARD
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Credential | RPT
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Telephone | 530-257-8989
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT12628
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License Number State | CA
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