Provider Demographics
NPI:1205955473
Name:YUBA CITY RACQUET CLUB, INC
Entity type:Organization
Organization Name:YUBA CITY RACQUET CLUB, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:TORBEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ULRICH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:530-673-0567
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:530-673-0567
Mailing Address - Fax:530-673-3026
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:530-673-3026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADF1964OtherRAILROAD MEDICARE
CAZZZ592552OtherBS GRP ID
CAZZZ592552OtherBS GRP ID