Basic Information
| Provider Information | |||||||||
| NPI: | 1457817157 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PLACER PHYSICAL THERAPY & SPORTS MEDICINE, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 670 AUBURN FOLSOM RD STE 106 | ||||||||
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| City: | AUBURN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956035647 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9168530255 | ||||||||
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| Practice Location | |||||||||
| Address1: | 670 AUBURN FOLSOM RD STE 106 | ||||||||
| Address2: | |||||||||
| City: | AUBURN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956035647 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9168530255 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/18/2019 | ||||||||
| LastUpdateDate: | 02/18/2019 | ||||||||
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| AuthorizedOfficialLastName: | BELCH | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9168530255 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DPT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.