Provider Demographics
NPI:1861408221
Name:THE PHYSICAL THERAPY CLINICS. INC.
Entity type:Organization
Organization Name:THE PHYSICAL THERAPY CLINICS. INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:916-747-3302
Mailing Address - Street 1:1550 HARBOR BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95691-3826
Mailing Address - Country:US
Mailing Address - Phone:916-375-1667
Mailing Address - Fax:916-375-1618
Practice Address - Street 1:1550 HARBOR BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95691-3826
Practice Address - Country:US
Practice Address - Phone:916-375-1667
Practice Address - Fax:916-375-1618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ18712ZMedicare ID - Type Unspecified