Provider Demographics
NPI:1710922455
Name:P.T. ON THE GO
Entity Type:Organization
Organization Name:P.T. ON THE GO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DELWYN
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:SITANGGANG
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:530-515-6890
Mailing Address - Street 1:PO BOX 701
Mailing Address - Street 2:
Mailing Address - City:PALO CEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:96073-0701
Mailing Address - Country:US
Mailing Address - Phone:530-515-6890
Mailing Address - Fax:530-222-2774
Practice Address - Street 1:2700 MADISON RIVER DR
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-5182
Practice Address - Country:US
Practice Address - Phone:530-515-6890
Practice Address - Fax:530-222-2774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25880225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty