Provider Demographics
NPI:1952481046
Name:ULRICH, TORBEN ROBERT (PT)
Entity Type:Individual
Prefix:
First Name:TORBEN
Middle Name:ROBERT
Last Name:ULRICH
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 1:825 JONES RD
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-6124
Mailing Address - Country:US
Mailing Address - Phone:530-674-9345
Mailing Address - Fax:
Practice Address - Street 1:825 JONES RD
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-6124
Practice Address - Country:US
Practice Address - Phone:530-673-0567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT257052251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA171680700OtherUS DEPT OF LABOR
CAZZZ59255ZOtherBLUE SHIELD
CA680397878OtherTAX ID #
CA680397878OtherTAX ID #