Provider Demographics
NPI:1982041612
Name:CENTRAL VALLEY PHYSICAL THERAPY, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:CENTRAL VALLEY PHYSICAL THERAPY, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KARRIE
Authorized Official - Middle Name:SUZANNE
Authorized Official - Last Name:GONZALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-219-8696
Mailing Address - Street 1:3333 LA PLAYA DR
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95618-6723
Mailing Address - Country:US
Mailing Address - Phone:530-219-8696
Mailing Address - Fax:530-746-0442
Practice Address - Street 1:125 N LINCOLN ST
Practice Address - Street 2:SUITE J
Practice Address - City:DIXON
Practice Address - State:CA
Practice Address - Zip Code:95620-3258
Practice Address - Country:US
Practice Address - Phone:530-219-8696
Practice Address - Fax:530-746-0442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-04
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT13201261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy