Provider Demographics
NPI:1851469845
Name:SACRAMENTO SPINE & PHYSICAL THERAPY INC.
Entity Type:Organization
Organization Name:SACRAMENTO SPINE & PHYSICAL THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:R
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-932-1210
Mailing Address - Street 1:1650 LEAD HILL BLVD
Mailing Address - Street 2:300
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3061
Mailing Address - Country:US
Mailing Address - Phone:916-677-1210
Mailing Address - Fax:
Practice Address - Street 1:1650 LEAD HILL BLVD
Practice Address - Street 2:300
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3061
Practice Address - Country:US
Practice Address - Phone:916-677-1210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ18195ZOtherMEDICARE PTAN