Provider Demographics
NPI:1477651347
Name:MURIETA PHYSICAL THERAPY
Entity Type:Organization
Organization Name:MURIETA PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:MINORU
Authorized Official - Last Name:YAMASHIRO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:916-354-0719
Mailing Address - Street 1:7281 LONE PINE DR # 104
Mailing Address - Street 2:PO BOX 955
Mailing Address - City:RANCHO MURIETA
Mailing Address - State:CA
Mailing Address - Zip Code:95683-9715
Mailing Address - Country:US
Mailing Address - Phone:916-354-0719
Mailing Address - Fax:916-354-1187
Practice Address - Street 1:7281 LONE PINE DR
Practice Address - Street 2:D104
Practice Address - City:RANCHO MURIETA
Practice Address - State:CA
Practice Address - Zip Code:95683-9715
Practice Address - Country:US
Practice Address - Phone:916-354-0719
Practice Address - Fax:916-354-1187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT17746225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty