Provider Demographics
NPI:1275526857
Name:EL DORADO PHYSICAL THERAPY & ASSOCIATES
Entity type:Organization
Organization Name:EL DORADO PHYSICAL THERAPY & ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLARDYCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-933-1221
Mailing Address - Street 1:907 EMBARCADERO DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-4087
Mailing Address - Country:US
Mailing Address - Phone:916-933-1221
Mailing Address - Fax:916-933-0871
Practice Address - Street 1:907 EMBARCADERO DR
Practice Address - Street 2:SUITE 1
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-4087
Practice Address - Country:US
Practice Address - Phone:916-933-1221
Practice Address - Fax:916-933-0871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-29
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT12308225100000X
CAPT12236225100000X
CAOT2576225XH1200X
CAPT21076225100000X
CAPT23471225100000X
CAPT19842225100000X
CAPT16222225100000X
CAPT27859225100000X
CAPT19561225100000X
CAPT27002225100000X
CAPT23929225100000X
CAPT13386225100000X
CAPT28491225100000X
CAPT28688225100000X
CAPT26040225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ57192ZOtherBLUE SHIELD OF CA
CAZZZ66063ZOtherBLUE SHIELD OF CA
CAZZZ66064ZOtherBLUE SHIELD OF CA
CAZZZ61857ZOtherBLUE SHIELD OF CA
CAZZZ66063ZOtherBLUE SHIELD OF CA