Provider Demographics
NPI:1568444073
Name:SPORTFIT PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:SPORTFIT PHYSICAL THERAPY INC
Other - Org Name:SPORTFIT PHYSICAL THERAPY I
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:LASSON
Authorized Official - Suffix:
Authorized Official - Credentials:VP
Authorized Official - Phone:408-570-0510
Mailing Address - Street 1:PO BOX 612260
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95161
Mailing Address - Country:US
Mailing Address - Phone:877-325-2776
Mailing Address - Fax:408-945-4011
Practice Address - Street 1:350 BOLLINGER CANYON LANE
Practice Address - Street 2:SUITE A
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583
Practice Address - Country:US
Practice Address - Phone:925-735-6414
Practice Address - Fax:925-735-6450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-18
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6566104OtherCIGNA
CA8153286OtherAETNA
ZZZ40525ZOtherBLUE SHIELD
ZZZ40525ZOtherBLUE SHIELD