Provider Demographics
NPI:1497788202
Name:FOLSOM PHYSICAL THERAPY AND TRAINING CENTER
Entity Type:Organization
Organization Name:FOLSOM PHYSICAL THERAPY AND TRAINING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST, CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:MCGONIGLE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:916-355-8500
Mailing Address - Street 1:115 NATOMA ST
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-2615
Mailing Address - Country:US
Mailing Address - Phone:916-355-8500
Mailing Address - Fax:916-355-8196
Practice Address - Street 1:115 NATOMA ST
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-2615
Practice Address - Country:US
Practice Address - Phone:916-355-8500
Practice Address - Fax:916-355-8196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA06030092251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ61124ZOtherBLUE SHIELD
CAZZZ61124ZOtherBLUE SHIELD