Provider Demographics
NPI:1629651260
Name:MAGEE, THERESA DOLORES (PT)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:DOLORES
Last Name:MAGEE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:DOLORES
Other - Last Name:ROCHE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2133 EDITH ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95864-0710
Mailing Address - Country:US
Mailing Address - Phone:916-837-4916
Mailing Address - Fax:
Practice Address - Street 1:8685 GREENBACK LN
Practice Address - Street 2:
Practice Address - City:ORANGEVALE
Practice Address - State:CA
Practice Address - Zip Code:95662-3987
Practice Address - Country:US
Practice Address - Phone:800-967-4667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-02
Last Update Date:2021-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13235225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist