MEDICARE: IVY HIN PT, DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	308861	CA

General Provider Information

NPI Number	:	1285593657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IVY HIN PT, DPT

Provider Business Mailing Address
First Line	:	2335 STOCKTON BLVD
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95817-2201
Country	:	US
Telephone Number	:	916-834-8191
Fax Number	:

Provider Business Practice Location Address
First Line	:	2335 STOCKTON BLVD
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95817-2201
Country	:	US
Telephone Number	:	916-834-8191
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/20/2026
Last Update Date	:	01/20/2026

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