Provider Demographics
NPI:1528057072
Name:YGNACIO VALLEY PHYS THERAPY
Entity type:Organization
Organization Name:YGNACIO VALLEY PHYS THERAPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ARLYN
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:VANDYKE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:925-820-0518
Mailing Address - Street 1:530 LA GONDA WAY
Mailing Address - Street 2:SUITE C
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-1727
Mailing Address - Country:US
Mailing Address - Phone:925-820-0518
Mailing Address - Fax:925-820-7247
Practice Address - Street 1:530 LA GONDA WAY
Practice Address - Street 2:SUITE C
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-1727
Practice Address - Country:US
Practice Address - Phone:925-820-0518
Practice Address - Fax:925-820-7247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-18
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT53672251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ17832ZMedicare PIN