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General NPI Number Information
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NPI Number | 1639491558
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Entity Type | Organization
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Legal Business Name | ACORN PHYSICAL THERAPY
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Dates
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Enumeration Date | 02/19/2010
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Last Update Date | 02/19/2010
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Provider Practice Location Address
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Address Line | 2075 HIGHWAY 4
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City | ARNOLD
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State | CA
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Zip | 95223
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Country | US
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Telephone | 209-795-3588
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Fax | 209-795-6785
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Provider Business Mailing Address
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Address Line | PO BOX 2834
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City | ARNOLD
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State | CA
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Zip | 95223-2834
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Country | US
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Telephone | 209-795-3588
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Fax | 209-795-6785
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. MICHAEL R. LEE
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Credential |
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Telephone | 209-795-3588
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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 | PT9740
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License Number State | CA
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