Provider Demographics
NPI:1326071598
Name:SIERRA SPORTS & PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:SIERRA SPORTS & PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:530-587-9355
Mailing Address - Street 1:12257 BUSINESS PARK DR STE 11
Mailing Address - Street 2:
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96161-3336
Mailing Address - Country:US
Mailing Address - Phone:530-587-9355
Mailing Address - Fax:530-587-3901
Practice Address - Street 1:12257 BUSINESS PARK DR STE 11
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-3336
Practice Address - Country:US
Practice Address - Phone:530-587-9355
Practice Address - Fax:530-587-3901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT7497225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty