1578860748 NPI number — TICE VALLEY PHYSCIAL THERAPY INC.

Table of content: (NPI 1578860748)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578860748 NPI number — TICE VALLEY PHYSCIAL THERAPY INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TICE VALLEY PHYSCIAL 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:
WALNUT CREEK PHYSICAL THERAPY AND SPORTS MEDICINE
Provider Other Organization Name Type Code:
3
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:
1578860748
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/23/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1874 TICE VALLEY BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALNUT CREEK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94595-2224
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-935-0510
Provider Business Mailing Address Fax Number:
925-935-0750

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 YGNACIO VALLEY RD STE 400
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALNUT CREEK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94596-4087
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-935-0510
Provider Business Practice Location Address Fax Number:
925-935-0750
Provider Enumeration Date:
02/23/2011

Additional Information

Authorized Official

Authorized Official Last Name:
DENDINGER
Authorized Official First Name:
DONALD
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PT/OWNER
Authorized Official Telephone Number:
925-935-0510

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  PT21277 , 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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