Provider Demographics
NPI:1700911054
Name:RIVER CITY PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:RIVER CITY PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHI
Authorized Official - Middle Name:MARGUERITE
Authorized Official - Last Name:THWEATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-456-3735
Mailing Address - Street 1:PO BOX 980545
Mailing Address - Street 2:
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95798-0545
Mailing Address - Country:US
Mailing Address - Phone:916-456-3735
Mailing Address - Fax:916-374-9753
Practice Address - Street 1:1550 HARBOR BLVD STE 120
Practice Address - Street 2:
Practice Address - City:W SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95691-3830
Practice Address - Country:US
Practice Address - Phone:916-456-3735
Practice Address - Fax:916-374-9753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 11212261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ31250ZMedicare UPIN