Provider Demographics
NPI:1972984938
Name:SAN RAMON VALLEY PHYSICAL THERAPY
Entity type:Organization
Organization Name:SAN RAMON VALLEY PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDERSLOOT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:925-552-5787
Mailing Address - Street 1:380 DIABLO RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-3461
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:380 DIABLO RD
Practice Address - Street 2:SUITE 201
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-3461
Practice Address - Country:US
Practice Address - Phone:925-552-5787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-16
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41997261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy