Provider Demographics
NPI:1154514040
Name:SANDS TRAVELER P.T.
Entity type:Organization
Organization Name:SANDS TRAVELER P.T.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER / DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:REYNALDO
Authorized Official - Middle Name:
Authorized Official - Last Name:PESINA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:530-832-1701
Mailing Address - Street 1:73795 S DELLEKER RD
Mailing Address - Street 2:
Mailing Address - City:PORTOLA
Mailing Address - State:CA
Mailing Address - Zip Code:96122-6402
Mailing Address - Country:US
Mailing Address - Phone:530-832-1701
Mailing Address - Fax:530-832-1703
Practice Address - Street 1:176 CRESCENT STREET
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:CA
Practice Address - Zip Code:95947
Practice Address - Country:US
Practice Address - Phone:530-284-1666
Practice Address - Fax:530-832-1703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy