Provider Demographics
NPI:1992787477
Name:CAMPUS COMMONS PHYSICAL THERAPY, INC.
Entity type:Organization
Organization Name:CAMPUS COMMONS PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:EDDY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:916-927-1333
Mailing Address - Street 1:601 UNIVERSITY AVE STE 185
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-6739
Mailing Address - Country:US
Mailing Address - Phone:916-927-1333
Mailing Address - Fax:916-927-1586
Practice Address - Street 1:601 UNIVERSITY AVE STE 185
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-6739
Practice Address - Country:US
Practice Address - Phone:916-927-1333
Practice Address - Fax:916-927-1586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-18
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ03086ZOtherBLUE SHIELD
197554800OtherDOL
CADA1522OtherRAILROAD
CA5318800OtherCIGNA
CAZZZ17850ZMedicare PIN