Provider Demographics
NPI:1669576930
Name:ALPINE PHYSICAL THERAPY & WELLNESS CENTER, INC
Entity type:Organization
Organization Name:ALPINE PHYSICAL THERAPY & WELLNESS CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:KRAEMER
Authorized Official - Suffix:
Authorized Official - Credentials:PT NCS
Authorized Official - Phone:619-445-3168
Mailing Address - Street 1:2549 ALPINE BLVD
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:CA
Mailing Address - Zip Code:91901-3950
Mailing Address - Country:US
Mailing Address - Phone:619-445-3168
Mailing Address - Fax:619-445-5368
Practice Address - Street 1:2549 ALPINE BLVD
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:CA
Practice Address - Zip Code:91901-3950
Practice Address - Country:US
Practice Address - Phone:619-445-3168
Practice Address - Fax:619-445-5368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT0211000Medicaid
CAGPT001571Medicaid
CAPT0211000Medicaid