Provider Demographics
NPI:1902823693
Name:THE PHYSICAL THERAPY CLINICS, INC.
Entity Type:Organization
Organization Name:THE PHYSICAL THERAPY CLINICS, INC.
Other - Org Name:PERFORMANCE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DEPUTY CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRINKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-759-8681
Mailing Address - Street 1:10390 COLOMA ROAD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-2152
Mailing Address - Country:US
Mailing Address - Phone:916-858-0950
Mailing Address - Fax:916-858-0972
Practice Address - Street 1:10390 COLOMA ROAD
Practice Address - Street 2:SUITE 7
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-2152
Practice Address - Country:US
Practice Address - Phone:916-858-0950
Practice Address - Fax:916-858-0972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ18712ZMedicare PIN