Basic Information
| Provider Information | |||||||||
| NPI: | 1477987261 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SCHAACK PHYSICAL THERAPY PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11344 COLOMA RD | ||||||||
| Address2: | STE 680 | ||||||||
| City: | GOLD RIVER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956704457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9163532270 | ||||||||
| FaxNumber: | 9163532279 | ||||||||
| Practice Location | |||||||||
| Address1: | 801 STERLING PKWY | ||||||||
| Address2: | STE 150 | ||||||||
| City: | LINCOLN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956487326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9165437900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2013 | ||||||||
| LastUpdateDate: | 08/28/2013 | ||||||||
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| AuthorizedOfficialLastName: | SCHAACK | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9165437900 | ||||||||
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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.