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NPI Code Detail

MEDICARE: PHYSICAL THERAPY AND WELLNESS CENTER, INC.

MEDICARE: PHYSICAL THERAPY AND WELLNESS CENTER, 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/CenterZZZ05206ZCA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
128428985OTHERCASTATE TAX ID

General Provider Information

NPI Number : 1922194786
Entity Type Code : Organization
Provider Name (Legal Business Name) : PHYSICAL THERAPY AND WELLNESS CENTER, INC.
Provider Business Mailing Address
First Line : 2490 S MAIN ST
Second Line :
City : RED BLUFF
State : CA
Zip : 96080-4337
Country : US
Telephone Number : 530-529-3636
Fax Number : 530-529-3797
Provider Business Practice Location Address
First Line : 2490 S MAIN ST
Second Line :
City : RED BLUFF
State : CA
Zip : 96080-4337
Country : US
Telephone Number : 530-529-3636
Fax Number : 530-529-3797
Authorized Official
Title or Position : BUSINESS MGR.
Name : LONNIE R. SCOTT
Credential :
Telephone Number : 530-529-3636
Provider Enumeration Date : 10/05/2006
Last Update Date : 08/22/2020

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