Provider Demographics
NPI:1598872376
Name:BAKERSFIELD SPORTS MEDICINE AND REHABILITATIVE PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:BAKERSFIELD SPORTS MEDICINE AND REHABILITATIVE PHYSICAL THERAPY INC
Other - Org Name:BAKERSFIELD SPORTS MEDICINE AND REHABILITATIVE THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DARIN
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:SIEBERT
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:661-834-2300
Mailing Address - Street 1:4300 STINE RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93313-2352
Mailing Address - Country:US
Mailing Address - Phone:661-834-2300
Mailing Address - Fax:661-834-2635
Practice Address - Street 1:4300 STINE RD
Practice Address - Street 2:SUITE 108
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93313-2352
Practice Address - Country:US
Practice Address - Phone:661-834-2300
Practice Address - Fax:661-834-2635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ18726ZMedicare ID - Type Unspecified