Provider Demographics
NPI:1225614068
Name:RIVER CITY MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:RIVER CITY MEDICAL GROUP, INC.
Other - Org Name:UNIVERSITY PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:CLOTHIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-228-4300
Mailing Address - Street 1:7311 GREENHAVEN DR STE 200
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-3594
Mailing Address - Country:US
Mailing Address - Phone:916-570-7900
Mailing Address - Fax:916-424-6024
Practice Address - Street 1:7311 GREENHAVEN DR STE 200
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95831-3594
Practice Address - Country:US
Practice Address - Phone:916-570-7900
Practice Address - Fax:916-424-6024
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RIVER CITY MEDICAL GROUP, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-03-22
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty