Provider Demographics
NPI:1558878918
Name:JAGDEEP GARCHA P.T
Entity Type:Organization
Organization Name:JAGDEEP GARCHA P.T
Other - Org Name:CRUX REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAGDEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCHA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:916-669-9038
Mailing Address - Street 1:1050 OPPORTUNITY DR STE 125
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-3030
Mailing Address - Country:US
Mailing Address - Phone:916-669-9038
Mailing Address - Fax:916-529-4161
Practice Address - Street 1:1050 OPPORTUNITY DR STE 125
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-3030
Practice Address - Country:US
Practice Address - Phone:916-669-9038
Practice Address - Fax:916-529-4161
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37541225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty