Provider Demographics
NPI:1952026650
Name:PRIME IMPACT PHYSICAL THERAPY
Entity Type:Organization
Organization Name:PRIME IMPACT PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SABRINA
Authorized Official - Middle Name:D
Authorized Official - Last Name:BURRI
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:916-992-3626
Mailing Address - Street 1:4120 DOUGLAS BLVD # 306-111
Mailing Address - Street 2:
Mailing Address - City:GRANITE BAY
Mailing Address - State:CA
Mailing Address - Zip Code:95746-5936
Mailing Address - Country:US
Mailing Address - Phone:916-844-2464
Mailing Address - Fax:
Practice Address - Street 1:2230 SUNSET BLVD STE 360
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-4274
Practice Address - Country:US
Practice Address - Phone:916-844-2464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty