Provider Demographics
NPI:1336295138
Name:PLEASANTON PHYSICAL THERAPY SERVICES, INC.
Entity Type:Organization
Organization Name:PLEASANTON PHYSICAL THERAPY SERVICES, INC.
Other - Org Name:BACK ON TRACK PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HITEN
Authorized Official - Middle Name:Y
Authorized Official - Last Name:DAVE
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:925-426-6986
Mailing Address - Street 1:301 LENNON LN
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2483
Mailing Address - Country:US
Mailing Address - Phone:925-934-6373
Mailing Address - Fax:925-934-3363
Practice Address - Street 1:4456 BLACK AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-6146
Practice Address - Country:US
Practice Address - Phone:925-426-6986
Practice Address - Fax:925-426-0277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT12931225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ31622ZMedicare ID - Type UnspecifiedGROUP ID