Provider Demographics
NPI:1497188817
Name:FOLSOM, IAN A (PT)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:A
Last Name:FOLSOM
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 HOWE AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-3913
Mailing Address - Country:US
Mailing Address - Phone:916-900-8758
Mailing Address - Fax:916-900-8394
Practice Address - Street 1:800 HOWE AVE STE 400
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-3913
Practice Address - Country:US
Practice Address - Phone:916-900-8758
Practice Address - Fax:916-900-8394
Is Sole Proprietor?:No
Enumeration Date:2013-08-21
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT40449225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist