Provider Demographics
NPI:1477605061
Name:ALL SPORTS THERAPY ATHLETIC REHAB
Entity Type:Organization
Organization Name:ALL SPORTS THERAPY ATHLETIC REHAB
Other - Org Name:ALL STAR
Other - Org Type:Other Name
Authorized Official - Title/Position:BUS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:MARGARET
Authorized Official - Last Name:AYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-582-9323
Mailing Address - Street 1:P.O. BOX 602
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93232
Mailing Address - Country:US
Mailing Address - Phone:559-582-9323
Mailing Address - Fax:559-582-0249
Practice Address - Street 1:311 N. DOWTY ST.
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93232
Practice Address - Country:US
Practice Address - Phone:559-582-9323
Practice Address - Fax:559-582-0249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT13939225100000X
261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty