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General NPI Number Information
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NPI Number | 1649757428
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Entity Type | Organization
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Legal Business Name | J. B. PHYSICAL THERAPY, INC.
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Dates
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Enumeration Date | 07/24/2018
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Last Update Date | 11/12/2018
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Provider Practice Location Address
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Address Line | 212 GREEN VALLEY ROAD
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City | FREEDOM
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State | CA
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Zip | 95019
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Country | US
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Telephone | 831-536-5115
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Fax | 833-264-6644
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Provider Business Mailing Address
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Address Line | 212 GREEN VALLEY ROAD
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City | FREEDOM
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State | CA
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Zip | 95019
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOSE BUGAY
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Credential | D.P.T.
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Telephone | 559-355-3160
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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 | PT27295
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License Number State | CA
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