Provider Demographics
NPI:1689801839
Name:FOOTHILL PHYSICAL THERAPY
Entity Type:Organization
Organization Name:FOOTHILL PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:FRANCES
Authorized Official - Last Name:HACKETT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:559-855-8840
Mailing Address - Street 1:31975 LODGE RD
Mailing Address - Street 2:
Mailing Address - City:AUBERRY
Mailing Address - State:CA
Mailing Address - Zip Code:93602-9753
Mailing Address - Country:US
Mailing Address - Phone:559-855-8840
Mailing Address - Fax:559-855-8178
Practice Address - Street 1:31975 LODGE RD
Practice Address - Street 2:
Practice Address - City:AUBERRY
Practice Address - State:CA
Practice Address - Zip Code:93602-9753
Practice Address - Country:US
Practice Address - Phone:559-855-8840
Practice Address - Fax:559-855-8178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-15
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 139920225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty