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Organization
EMERALD BAY PHYSICAL THERAPY PC
Active
Organization
EMERALD BAY PHYSICAL THERAPY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STACEY A MULLINS (BILLER/CREDENTIALING SPECIALIST)
(530) 314-3971
Entity
Organization
Contact information
Practice address
812 EMERALD BAY RD, SOUTH LAKE TAHOE, CA 96150-6413
(530) 542-2662
(530) 542-2661
Mailing address
812 EMERALD BAY RD, SOUTH LAKE TAHOE, CA 96150-6413
(530) 542-2662
(530) 542-2661
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
NULL
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
Other
Enumeration date
10/10/2022
Last updated
12/28/2023
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