Provider Demographics
NPI:1861422818
Name:EUREKA PHYSICAL THERAPY
Entity type:Organization
Organization Name:EUREKA PHYSICAL THERAPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:PAUP
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:707-443-8354
Mailing Address - Street 1:2306 DEAN ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-3209
Mailing Address - Country:US
Mailing Address - Phone:707-443-8354
Mailing Address - Fax:707-443-8628
Practice Address - Street 1:2306 DEAN ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-3209
Practice Address - Country:US
Practice Address - Phone:707-443-8354
Practice Address - Fax:707-443-8628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACH2219OtherRR MEDICARE #
CAZZZ18018ZMedicare PIN
CAZZZ26450ZMedicare PIN
CACH2219OtherRR MEDICARE #
CACH2219OtherRR MEDICARE #