Provider Demographics
NPI:1750307674
Name:AMERICAN RIVER REHABILITATION, INCORPORATED
Entity Type:Organization
Organization Name:AMERICAN RIVER REHABILITATION, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HALLORAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:530-889-0478
Mailing Address - Street 1:PO BOX 7121
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95604-7121
Mailing Address - Country:US
Mailing Address - Phone:530-889-0478
Mailing Address - Fax:
Practice Address - Street 1:12055 PERSIMMON TER
Practice Address - Street 2:STE. 130
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-3808
Practice Address - Country:US
Practice Address - Phone:530-889-0478
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ25397ZMedicare ID - Type UnspecifiedGROUP ID NUMBER