Provider Demographics
NPI:1083717607
Name:VALPONI&WAGNER PHYSICAL THERAPY, INC
Entity Type:Organization
Organization Name:VALPONI&WAGNER PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:M
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:PT, CHT
Authorized Official - Phone:530-894-0221
Mailing Address - Street 1:1430 ESPLANADE
Mailing Address - Street 2:#8
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-3366
Mailing Address - Country:US
Mailing Address - Phone:530-894-0221
Mailing Address - Fax:530-894-0285
Practice Address - Street 1:1430 ESPLANADE
Practice Address - Street 2:#8
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-3366
Practice Address - Country:US
Practice Address - Phone:530-894-0221
Practice Address - Fax:530-894-0285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT0101350Medicaid
CA697197OtherACN
CAOPT101350OtherBLUE SHIELD
CAOPT101350Medicare PIN