Basic Information
| Provider Information | |||||||||
| NPI: | 1528040037 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CALIFORNIA SPORTS PHYSICAL THERAPY CENTERS, INC. | ||||||||
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| OtherOrganizationName: | VALLEY PHYSICAL THERAPY GROUP | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2000 GARDEN RD | ||||||||
| Address2: | |||||||||
| City: | MONTEREY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939405313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8313751885 | ||||||||
| FaxNumber: | 8313757436 | ||||||||
| Practice Location | |||||||||
| Address1: | 1306 W AVENUE J | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | LANCASTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6619480186 | ||||||||
| FaxNumber: | 6619455736 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2005 | ||||||||
| LastUpdateDate: | 01/25/2016 | ||||||||
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| AuthorizedOfficialLastName: | DOCKERY | ||||||||
| AuthorizedOfficialFirstName: | JONATHAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT OF REVENUE CYCLE | ||||||||
| AuthorizedOfficialTelephone: | 7606024105 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.