Provider Demographics
NPI:1902861602
Name:RED BLUFF PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:RED BLUFF PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTANA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:530-529-5777
Mailing Address - Street 1:PO BOX 496084
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96049-6084
Mailing Address - Country:US
Mailing Address - Phone:530-241-0473
Mailing Address - Fax:530-241-5377
Practice Address - Street 1:100 JACKSON ST
Practice Address - Street 2:
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96080-3954
Practice Address - Country:US
Practice Address - Phone:530-529-5777
Practice Address - Fax:530-529-5772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT14685225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ135352OtherBLUE SHIELD GROUP NUMBER
CAPT0146850Medicaid
P00052571OtherRAIL ROAD MEDICARE PIN
CAZZZ26923ZMedicare ID - Type Unspecified
ZZZ135352OtherBLUE SHIELD GROUP NUMBER