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General NPI Number Information
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NPI Number | 1699981589
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Entity Type | Organization
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Legal Business Name | COTTONWOOD PHYSICAL THERAPY, INC.
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 05/22/2008
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Provider Practice Location Address
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Address Line | 20633 GAS POINT RD STE J
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City | COTTONWOOD
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State | CA
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Zip | 96022-9296
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Country | US
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Telephone | 530-347-4195
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Fax | 530-347-4192
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Provider Business Mailing Address
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Address Line | PO BOX 990955
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City | REDDING
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State | CA
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Zip | 96099-0955
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Country | US
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Telephone | 530-243-2164
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Fax | 530-347-4192
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Authorized Official
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Title or Position | PRESIDENT
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Name | JASON EARL WHITE
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Credential | PT
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Telephone | 530-347-4195
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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 | PT24103
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License Number State | CA
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