Provider Demographics
NPI:1053490011
Name:COOL PHYSICAL THERAPY AND SPEECH SERVICES
Entity Type:Organization
Organization Name:COOL PHYSICAL THERAPY AND SPEECH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MPT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:CLAYTON
Authorized Official - Last Name:KREUTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-887-9598
Mailing Address - Street 1:5000 ELLINGHOUSE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:COOL
Mailing Address - State:CA
Mailing Address - Zip Code:95614-9568
Mailing Address - Country:US
Mailing Address - Phone:530-887-9598
Mailing Address - Fax:530-887-9512
Practice Address - Street 1:5000 ELLINGHOUSE DR STE 100
Practice Address - Street 2:
Practice Address - City:COOL
Practice Address - State:CA
Practice Address - Zip Code:95614-9568
Practice Address - Country:US
Practice Address - Phone:530-887-9598
Practice Address - Fax:530-887-9512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 26148225100000X
CA13073235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty