Provider Demographics
NPI:1821166547
Name:MAGNUSON, RALPH CHRISTOPHER (PT)
Entity Type:Individual
Prefix:MR
First Name:RALPH
Middle Name:CHRISTOPHER
Last Name:MAGNUSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3278 BECHELLI LN
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-2005
Mailing Address - Country:US
Mailing Address - Phone:530-223-9474
Mailing Address - Fax:530-223-6937
Practice Address - Street 1:3278 BECHELLI LN
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-2005
Practice Address - Country:US
Practice Address - Phone:530-223-9474
Practice Address - Fax:530-223-6937
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT16216225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT0162160Medicaid
ZZZ26923ZOtherMEDICARE GROUP NUMBER
CABI072Medicare PIN
CA0PT162160Medicare PIN