Provider Demographics
NPI:1609857945
Name:FOOTHILL PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:FOOTHILL PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:GLIDEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:916-934-0914
Mailing Address - Street 1:1106 WINDFIELD WAY
Mailing Address - Street 2:SUITE 4
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762
Mailing Address - Country:US
Mailing Address - Phone:916-934-0914
Mailing Address - Fax:916-934-0960
Practice Address - Street 1:1106 WINDFIELD WAY
Practice Address - Street 2:SUITE 4
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762
Practice Address - Country:US
Practice Address - Phone:916-934-0914
Practice Address - Fax:916-934-0960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-11
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA201042000OtherACS-DEPT. OF LABOR ID #
CA201042000OtherACS-DEPT. OF LABOR ID #
CAZZZ272052Medicare UPIN