Provider Demographics
NPI:1275526857
Name:EL DORADO PHYSICAL THERAPY & ASSOCIATES
Entity Type:Organization
Organization Name:EL DORADO PHYSICAL THERAPY & ASSOCIATES
Other - Org Name:EL DORADO PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLARDYCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-933-1221
Mailing Address - Street 1:907 EMBARCADERO DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-4087
Mailing Address - Country:US
Mailing Address - Phone:916-933-1221
Mailing Address - Fax:916-933-0871
Practice Address - Street 1:907 EMBARCADERO DR
Practice Address - Street 2:SUITE 1
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-4087
Practice Address - Country:US
Practice Address - Phone:916-933-1221
Practice Address - Fax:916-933-0871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT12308225100000X
CAPT12236225100000X
CAPT21076225100000X
CAPT23471225100000X
CAPT19842225100000X
CAPT16222225100000X
CAPT27859225100000X
CAPT19561225100000X
CAPT27002225100000X
CAPT23929225100000X
CAPT13386225100000X
CAPT28491225100000X
CAPT28688225100000X
CAPT26040225100000X
CAOT2576225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Not Answered225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ57192ZOtherBLUE SHIELD OF CA
CAZZZ66063ZOtherBLUE SHIELD OF CA
CAZZZ66064ZOtherBLUE SHIELD OF CA
CAZZZ61857ZOtherBLUE SHIELD OF CA
CAZZZ66063ZOtherBLUE SHIELD OF CA