1740216332 NPI number — WESTERN 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 1740216332 NPI number — WESTERN PHYSICAL THERAPY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WESTERN 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:
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:
1740216332
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/25/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 493396
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REDDING
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
96049-3396
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-221-9952
Provider Business Mailing Address Fax Number:
530-221-9954

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
844 BRIDGE ST
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
COLUSA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95932-2836
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-458-7770
Provider Business Practice Location Address Fax Number:
530-458-7735
Provider Enumeration Date:
06/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BAAS
Authorized Official First Name:
DONALD
Authorized Official Middle Name:
ROY
Authorized Official Title or Position:
CO-OWNER PHYSICAL THERAPIST
Authorized Official Telephone Number:
530-221-9952

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  0000001948 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: GPT001010 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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