1568615979 NPI number — PACER PHYSICAL THERAPY, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568615979 NPI number — PACER PHYSICAL THERAPY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PACER PHYSICAL THERAPY, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568615979
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/01/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2255 YGNACIO VALLEY RD
Provider Second Line Business Mailing Address:
SUITE E
Provider Business Mailing Address City Name:
WALNUT CREEK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94598-3343
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-930-6680
Provider Business Mailing Address Fax Number:
925-930-7867

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2330 SAN RAMON VALLEY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN RAMON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94583-1608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-855-1733
Provider Business Practice Location Address Fax Number:
925-855-1758
Provider Enumeration Date:
10/29/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BAJADA
Authorized Official First Name:
TANIA
Authorized Official Middle Name:
F.
Authorized Official Title or Position:
DIRECTOR/PHYSICAL THERAPIST
Authorized Official Telephone Number:
925-930-6680

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  PT26394 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PT26394 . This is a "PHYSICAL THERAPY LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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