Provider Demographics
NPI:1679827166
Name:MERCED PHYSICAL THERAPY AND SPORTS MEDICINE REHAB LLC
Entity Type:Organization
Organization Name:MERCED PHYSICAL THERAPY AND SPORTS MEDICINE REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:PINKY
Authorized Official - Middle Name:
Authorized Official - Last Name:PARIKH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:209-812-1448
Mailing Address - Street 1:PO BOX 2328
Mailing Address - Street 2:C
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95344-0328
Mailing Address - Country:US
Mailing Address - Phone:209-812-1448
Mailing Address - Fax:209-812-1445
Practice Address - Street 1:2908 G ST
Practice Address - Street 2:C
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-2106
Practice Address - Country:US
Practice Address - Phone:209-812-1448
Practice Address - Fax:209-812-1445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36890172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172M00000XOther Service ProvidersMechanotherapistGroup - Single Specialty