Provider Demographics
NPI:1659563393
Name:COARSEGOLD PHYSICAL THERAPY, INCORPORATED
Entity Type:Organization
Organization Name:COARSEGOLD PHYSICAL THERAPY, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:LAPHAM
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:559-760-7012
Mailing Address - Street 1:35324 HIGHWAY 41
Mailing Address - Street 2:SUITE D
Mailing Address - City:COARSEGOLD
Mailing Address - State:CA
Mailing Address - Zip Code:93614-9285
Mailing Address - Country:US
Mailing Address - Phone:559-641-5445
Mailing Address - Fax:559-641-5449
Practice Address - Street 1:35324 HIGHWAY 41
Practice Address - Street 2:SUITE D
Practice Address - City:COARSEGOLD
Practice Address - State:CA
Practice Address - Zip Code:93614-9285
Practice Address - Country:US
Practice Address - Phone:559-641-5445
Practice Address - Fax:559-641-5449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-16
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT18588225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty