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Organization
SANDS TRAVELERS PT, INC.
Active
Organization
SANDS TRAVELERS PT, INC.
Active
Other names
Sierra Valley Physical Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. REYNALDO PESINA PT (CEO)
(530) 283-0313
Entity
Organization
Contact information
Practice address
72795 S DELLEKER, PORTOLA, CA 96122
(530) 283-0313
Mailing address
72795 S DELLEKER, PORTOLA, CA 96122
(530) 283-0313
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
171530200
DEPARTMENT OF LABOR
CA
01
—
ZZZ03308Z
BLUE SHIELD
CA
Enumeration date
01/19/2007
Last updated
09/08/2009
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