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General NPI Number Information
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NPI Number | 1831621291
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Entity Type | Organization
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Legal Business Name | VITALITY FRP MULTIDISCIPLINARY PSYCHOLOGY AND PHYSIOTHERAPY FOR CHRONI
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Dates
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Enumeration Date | 04/03/2017
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Last Update Date | 04/03/2017
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Provider Practice Location Address
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Address Line | 1650 LEAD HILL BLVD
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City | ROSEVILLE
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State | CA
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Zip | 95661-3061
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Country | US
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Telephone | 510-967-2474
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Fax |
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Provider Business Mailing Address
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Address Line | 1640 AINSDALE DR
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City | ROSEVILLE
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State | CA
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Zip | 95747-5838
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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 | HEATHER MARTARELLA
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Credential |
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Telephone | 510-967-2474
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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 | PT19666
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY21758
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License Number State | CA
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