Basic Information
| Provider Information | |||||||||
| NPI: | 1548408735 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DUBLIN PHYSICAL THERAPY, INC | ||||||||
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| OtherOrganizationName: | SPINE AND SPORTS PHYSICAL THERAPY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6759 SIERRA CT | ||||||||
| Address2: | SUITE A | ||||||||
| City: | DUBLIN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945682670 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9258030530 | ||||||||
| FaxNumber: | 9258032047 | ||||||||
| Practice Location | |||||||||
| Address1: | 6759 SIERRA CT | ||||||||
| Address2: | SUITE A | ||||||||
| City: | DUBLIN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945682670 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9258030530 | ||||||||
| FaxNumber: | 9258032047 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2009 | ||||||||
| LastUpdateDate: | 07/24/2014 | ||||||||
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| AuthorizedOfficialLastName: | ROJAS | ||||||||
| AuthorizedOfficialFirstName: | NIOMI | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9258030530 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | DUBLIN PHYSICAL THERAPY, INC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 32822 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 225100000X | 01 | CA | PHYSICAL THERAPIST | OTHER |