1124000682 NPI number — CALIFORNIA SPORTS PHYSICAL THERAPY CENTERS, INC.

Table of content: DR. RYAN SCOTT ROBINSON D.M.D. (NPI 1275975641)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124000682 NPI number — CALIFORNIA SPORTS PHYSICAL THERAPY CENTERS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CALIFORNIA SPORTS PHYSICAL THERAPY CENTERS, 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:
6
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:
1124000682
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/25/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2000 GARDEN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTEREY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93940-5313
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
831-375-1885
Provider Business Mailing Address Fax Number:
831-375-7436

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2230 GLADSTONE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PITTSBURG
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94565-5121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-427-5155
Provider Business Practice Location Address Fax Number:
925-427-9552
Provider Enumeration Date:
11/18/2005

Additional Information

Authorized Official

Authorized Official Last Name:
DOCKERY
Authorized Official First Name:
JONATHAN
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT OF REVENUE CYCLE
Authorized Official Telephone Number:
760-602-4105

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT 26479 , 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)





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