Basic Information
| Provider Information | |||||||||
| NPI: | 1467402016 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HIGH DESERT THERAPISTS, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2874 N CARSON ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | CARSON CITY | ||||||||
| State: | NV | ||||||||
| PostalCode: | 897060177 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7758834161 | ||||||||
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| Practice Location | |||||||||
| Address1: | 60 PENNY LANE | ||||||||
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| City: | WATSONVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950763079 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8317869000 | ||||||||
| FaxNumber: | 8317869100 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2006 | ||||||||
| LastUpdateDate: | 12/26/2013 | ||||||||
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| AuthorizedOfficialLastName: | STEPHENSON | ||||||||
| AuthorizedOfficialFirstName: | LENDELL | ||||||||
| AuthorizedOfficialMiddleName: | RICHARD | ||||||||
| AuthorizedOfficialTitleorPosition: | PT/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7758834161 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | RPT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.