Provider Demographics
NPI:1477967974
Name:BOLLINGER, VERNON AUSTIN (RPT)
Entity type:Individual
Prefix:
First Name:VERNON
Middle Name:AUSTIN
Last Name:BOLLINGER
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:115 NATOMA ST
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-2615
Mailing Address - Country:US
Mailing Address - Phone:916-355-8500
Mailing Address - Fax:916-353-2279
Practice Address - Street 1:11344 COLOMA RD
Practice Address - Street 2:STE 680
Practice Address - City:GOLD RIVER
Practice Address - State:CA
Practice Address - Zip Code:95670-4457
Practice Address - Country:US
Practice Address - Phone:916-853-0255
Practice Address - Fax:916-853-0259
Is Sole Proprietor?:No
Enumeration Date:2014-06-12
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT41347225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist