Provider Demographics
NPI:1932206828
Name:ORTHO-SPORTS PT, INC
Entity Type:Organization
Organization Name:ORTHO-SPORTS PT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:D
Authorized Official - Last Name:NORTON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:510-644-3668
Mailing Address - Street 1:2917 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2203
Mailing Address - Country:US
Mailing Address - Phone:510-644-3668
Mailing Address - Fax:510-644-0418
Practice Address - Street 1:2917 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2203
Practice Address - Country:US
Practice Address - Phone:510-644-3668
Practice Address - Fax:510-644-0418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy