Provider Demographics
NPI:1770869711
Name:SPRING HILL PHYSICAL THERAPY PC
Entity type:Organization
Organization Name:SPRING HILL PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIEBOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-274-2320
Mailing Address - Street 1:300 SIERRA COLLEGE DR
Mailing Address - Street 2:SUITE 165
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5082
Mailing Address - Country:US
Mailing Address - Phone:530-274-2320
Mailing Address - Fax:530-274-1568
Practice Address - Street 1:300 SIERRA COLLEGE DR
Practice Address - Street 2:SUITE 165
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5082
Practice Address - Country:US
Practice Address - Phone:530-274-2320
Practice Address - Fax:530-274-1568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-21
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFX548AMedicare PIN