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General NPI Number Information
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NPI Number | 1992787477
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Entity Type | Organization
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Legal Business Name | CAMPUS COMMONS PHYSICAL THERAPY, INC.
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Dates
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Enumeration Date | 11/18/2005
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Last Update Date | 11/27/2017
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Provider Practice Location Address
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Address Line | 601 UNIVERSITY AVE STE 185
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City | SACRAMENTO
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State | CA
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Zip | 95825-6739
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Country | US
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Telephone | 916-927-1333
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Fax | 916-927-1586
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Provider Business Mailing Address
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Address Line | 601 UNIVERSITY AVE STE 185
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City | SACRAMENTO
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State | CA
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Zip | 95825-6739
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Country | US
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Telephone | 916-927-1333
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Fax | 916-927-1586
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Authorized Official
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Title or Position | OWNER
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Name | MARK D EDDY
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Credential | P.T.
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Telephone | 916-927-1333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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