Provider Demographics
NPI:1346510310
Name:MOUNTAIN PHYSICAL THERAPY
Entity Type:Organization
Organization Name:MOUNTAIN PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JOAQUIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:VARGAS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:530-249-1520
Mailing Address - Street 1:20 CRESCENT ST
Mailing Address - Street 2:B
Mailing Address - City:QUINCY
Mailing Address - State:CA
Mailing Address - Zip Code:95971-9118
Mailing Address - Country:US
Mailing Address - Phone:530-283-2291
Mailing Address - Fax:530-283-2292
Practice Address - Street 1:20 CRESCENT ST
Practice Address - Street 2:B
Practice Address - City:QUINCY
Practice Address - State:CA
Practice Address - Zip Code:95971-9118
Practice Address - Country:US
Practice Address - Phone:530-283-2291
Practice Address - Fax:530-283-2292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-09
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT6440174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1215929328OtherNPI PHYSICAL THERAPY