Provider Demographics
NPI:1295135390
Name:BAUDENDISTEL PHYSICAL THERAPY
Entity type:Organization
Organization Name:BAUDENDISTEL PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:BAUDENDISTEL
Authorized Official - Suffix:
Authorized Official - Credentials:PT, OCS, COMT
Authorized Official - Phone:916-487-4681
Mailing Address - Street 1:3609 MISSION AVE STE C
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-2955
Mailing Address - Country:US
Mailing Address - Phone:916-487-4681
Mailing Address - Fax:
Practice Address - Street 1:3609 MISSION AVE STE C
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-2955
Practice Address - Country:US
Practice Address - Phone:916-487-4681
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-26
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA224312251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA571-11-5122OtherNPI