Provider Demographics
NPI:1861457418
Name:AMUNDSON PHYSICAL THERAPY
Entity Type:Organization
Organization Name:AMUNDSON PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER RELATIONS
Authorized Official - Prefix:
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-224-3322
Mailing Address - Street 1:2520 GOODWATER AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-1514
Mailing Address - Country:US
Mailing Address - Phone:530-224-3322
Mailing Address - Fax:530-224-3325
Practice Address - Street 1:638 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96080-3321
Practice Address - Country:US
Practice Address - Phone:530-528-9112
Practice Address - Fax:530-529-9398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT8266225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ32373ZOtherMEDICARE GROUP
ZZZ66069ZOtherBLUE SHIELD GROUP
ZZZ66069ZOtherBLUE SHIELD GROUP