Provider Demographics
NPI:1922194786
Name:PHYSICAL THERAPY AND WELLNESS CENTER, INC.
Entity Type:Organization
Organization Name:PHYSICAL THERAPY AND WELLNESS CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MGR.
Authorized Official - Prefix:
Authorized Official - First Name:LONNIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-529-3636
Mailing Address - Street 1:2490 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RED BLUFF
Mailing Address - State:CA
Mailing Address - Zip Code:96080-4337
Mailing Address - Country:US
Mailing Address - Phone:530-529-3636
Mailing Address - Fax:530-529-3797
Practice Address - Street 1:2490 S MAIN ST
Practice Address - Street 2:
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96080-4337
Practice Address - Country:US
Practice Address - Phone:530-529-3636
Practice Address - Fax:530-529-3797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAZZZ05206Z261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA28428985OtherSTATE TAX ID