Provider Demographics
NPI:1992985493
Name:SEQUOIA PHYSICAL TERAPY, INC.
Entity type:Organization
Organization Name:SEQUOIA PHYSICAL TERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-335-6388
Mailing Address - Street 1:415 N TUSTIN ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-7777
Mailing Address - Country:US
Mailing Address - Phone:714-744-8244
Mailing Address - Fax:714-744-8211
Practice Address - Street 1:415 N TUSTIN ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867-7777
Practice Address - Country:US
Practice Address - Phone:714-744-8244
Practice Address - Fax:714-744-8211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW16967AMedicare UPIN