Provider Demographics
NPI:1043363542
Name:SANDS TRAVELER PT, INC.
Entity Type:Organization
Organization Name:SANDS TRAVELER PT, INC.
Other - Org Name:DBA SIERRA VALLEY PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:REYNALDO
Authorized Official - Middle Name:
Authorized Official - Last Name:PESINA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:530-283-0313
Mailing Address - Street 1:72795 S DELLEKER
Mailing Address - Street 2:
Mailing Address - City:PORTOLA
Mailing Address - State:CA
Mailing Address - Zip Code:96122
Mailing Address - Country:US
Mailing Address - Phone:530-283-0313
Mailing Address - Fax:
Practice Address - Street 1:76 CRESENT
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:CA
Practice Address - Zip Code:95971
Practice Address - Country:US
Practice Address - Phone:530-283-0313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT17342174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ03444ZMedicare ID - Type Unspecified