Provider Demographics
NPI:1073540399
Name:PARRY PHYSICAL THERAPY & ATHLETIC ENHANCEMENT, INC.
Entity Type:Organization
Organization Name:PARRY PHYSICAL THERAPY & ATHLETIC ENHANCEMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:PARRY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:916-455-5524
Mailing Address - Street 1:3401 FOLSOM BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5354
Mailing Address - Country:US
Mailing Address - Phone:916-455-5524
Mailing Address - Fax:916-455-5524
Practice Address - Street 1:3401 FOLSOM BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5354
Practice Address - Country:US
Practice Address - Phone:916-455-5524
Practice Address - Fax:916-455-5524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2007-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT21001261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ02667ZMedicare PIN