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NPI Code Detail

MEDICARE: GOLD COUNTRY THERAPIES, INC

MEDICARE: GOLD COUNTRY THERAPIES, INC
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
1261QP2000XPhysical Therapy Clinic/Center

General Provider Information

NPI Number : 1447658067
Entity Type Code : Organization
Provider Name (Legal Business Name) : GOLD COUNTRY THERAPIES, INC
Provider Business Mailing Address
First Line : 10B VISTA DEL LAGO DR
Second Line :
City : VALLEY SPRINGS
State : CA
Zip : 95252-8796
Country : US
Telephone Number : 209-772-0848
Fax Number :
Provider Business Practice Location Address
First Line : 10B VISTA DEL LAGO DR
Second Line :
City : VALLEY SPRINGS
State : CA
Zip : 95252-8796
Country : US
Telephone Number : 209-772-0848
Fax Number :
Authorized Official
Title or Position : OWNER
Name : LEAH ROBITAILLE
Credential : DPT
Telephone Number : 209-772-0848
Provider Enumeration Date : 12/13/2014
Last Update Date : 12/13/2014

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Directions to “GOLD COUNTRY THERAPIES, INC ” Practice Location

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