Provider Demographics
NPI:1518924604
Name:VALLEY SPRINGS PHYSICAL THERAPY
Entity Type:Organization
Organization Name:VALLEY SPRINGS PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARLINE
Authorized Official - Middle Name:L
Authorized Official - Last Name:JUAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-772-0898
Mailing Address - Street 1:10B VISTA DEL LAGO DR
Mailing Address - Street 2:
Mailing Address - City:VALLEY SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:95252-8796
Mailing Address - Country:US
Mailing Address - Phone:209-772-0848
Mailing Address - Fax:209-772-8533
Practice Address - Street 1:10B VISTA DEL LAGO DR
Practice Address - Street 2:
Practice Address - City:VALLEY SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:95252-8796
Practice Address - Country:US
Practice Address - Phone:209-772-0848
Practice Address - Fax:209-772-8533
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEAH MICHELLE ROBITAILLE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-01
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1043516560OtherSOLE PROPRIETORS NPI
CA1043516560OtherSOLE PROPRIETORS NPI