Provider Demographics
NPI:1568615979
Name:PACER PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:PACER PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/PHYSICAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:TANIA
Authorized Official - Middle Name:F
Authorized Official - Last Name:BAJADA
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:925-930-6680
Mailing Address - Street 1:2255 YGNACIO VALLEY RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-3343
Mailing Address - Country:US
Mailing Address - Phone:925-930-6680
Mailing Address - Fax:925-930-7867
Practice Address - Street 1:2330 SAN RAMON VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1608
Practice Address - Country:US
Practice Address - Phone:925-855-1733
Practice Address - Fax:925-855-1758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-29
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT26394174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT26394OtherPHYSICAL THERAPY LICENSE