Provider Demographics
NPI:1164581997
Name:PALM DESERT PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:PALM DESERT PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZUNIGA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:760-345-3087
Mailing Address - Street 1:77622 COUNTRY CLUB DR STE G
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-0447
Mailing Address - Country:US
Mailing Address - Phone:760-345-3087
Mailing Address - Fax:760-345-6852
Practice Address - Street 1:77622 COUNTRY CLUB DR
Practice Address - Street 2:STE G
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211
Practice Address - Country:US
Practice Address - Phone:760-345-3087
Practice Address - Fax:760-345-6852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-07
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT29635225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ65614ZOtherBLUE SHIELD OF CALIFORNIA
CAZZZ65614ZOtherBLUE SHIELD OF CALIFORNIA
CAZZZ65614ZOtherBLUE SHIELD OF CALIFORNIA