Provider Demographics
NPI:1992990865
Name:STOCKTON PHYSICAL THERAPY AND LYMPHEDEMA CLINIC, INC
Entity type:Organization
Organization Name:STOCKTON PHYSICAL THERAPY AND LYMPHEDEMA CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:VIRTU
Authorized Official - Middle Name:
Authorized Official - Last Name:ARORA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:209-464-0200
Mailing Address - Street 1:221 TUXEDO CT
Mailing Address - Street 2:SUITE - B
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-5261
Mailing Address - Country:US
Mailing Address - Phone:209-464-0200
Mailing Address - Fax:209-464-0220
Practice Address - Street 1:221 TUXEDO CT
Practice Address - Street 2:SUITE - B
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-5261
Practice Address - Country:US
Practice Address - Phone:209-464-0200
Practice Address - Fax:209-464-0220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2009-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT25932261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy