Provider Demographics
NPI:1073638698
Name:TORREY-NICKERSON PHYSICAL THERAPY
Entity Type:Organization
Organization Name:TORREY-NICKERSON PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:V
Authorized Official - Last Name:TORREY
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:916-353-2270
Mailing Address - Street 1:11251 COLOMA RD
Mailing Address - Street 2:STE J
Mailing Address - City:GOLD RIVER
Mailing Address - State:CA
Mailing Address - Zip Code:95670-4431
Mailing Address - Country:US
Mailing Address - Phone:916-353-2270
Mailing Address - Fax:916-353-2279
Practice Address - Street 1:2801 K ST
Practice Address - Street 2:STE 310
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5120
Practice Address - Country:US
Practice Address - Phone:916-353-2270
Practice Address - Fax:916-353-2279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT9048174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ01587ZMedicare ID - Type UnspecifiedMEDICARE GROUP