Provider Demographics
NPI:1689181778
Name:ANTIOCH PHYSICAL THERAPY AND SPORTS INJURY CENTER INC.
Entity Type:Organization
Organization Name:ANTIOCH PHYSICAL THERAPY AND SPORTS INJURY CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:COUCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-754-6262
Mailing Address - Street 1:4041 LONE TREE WAY STE 106
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94531-6208
Mailing Address - Country:US
Mailing Address - Phone:925-754-6262
Mailing Address - Fax:925-754-2198
Practice Address - Street 1:4041 LONE TREE WAY STE 106
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531-6208
Practice Address - Country:US
Practice Address - Phone:925-754-6262
Practice Address - Fax:925-754-2198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-10
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy