Provider Demographics
NPI:1508520834
Name:CAMPBELL'S PREMIER PHYSICAL THERAPY, INC
Entity Type:Organization
Organization Name:CAMPBELL'S PREMIER PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DERINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARLICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-866-5567
Mailing Address - Street 1:163 E HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-0245
Mailing Address - Country:US
Mailing Address - Phone:408-866-5567
Mailing Address - Fax:408-866-1317
Practice Address - Street 1:163 E HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-0245
Practice Address - Country:US
Practice Address - Phone:408-866-5567
Practice Address - Fax:408-866-1317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-22
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty