Provider Demographics
NPI:1740216332
Name:WESTERN PHYSICAL THERAPY, INC.
Entity type:Organization
Organization Name:WESTERN PHYSICAL THERAPY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:ROY
Authorized Official - Last Name:BAAS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:530-221-9952
Mailing Address - Street 1:PO BOX 493396
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96049-3396
Mailing Address - Country:US
Mailing Address - Phone:530-221-9952
Mailing Address - Fax:530-221-9954
Practice Address - Street 1:844 BRIDGE ST
Practice Address - Street 2:SUITE C
Practice Address - City:COLUSA
Practice Address - State:CA
Practice Address - Zip Code:95932-2836
Practice Address - Country:US
Practice Address - Phone:530-458-7770
Practice Address - Fax:530-458-7735
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WESTERN PHYSICAL THERAPY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-24
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0000001948225100000X
261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGPT001010Medicaid
CAZZZ31993ZMedicare ID - Type UnspecifiedMEDICARE NUMBER