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Organization
PACIFIC PHYSICAL THERAPY INC.
Active
Organization
PACIFIC PHYSICAL THERAPY INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAMMY GAYLE PATRICK RPT (PRESIDENT)
(707) 964-1208
Entity
Organization
Contact information
Practice address
121 BOATYARD DR, STE A, FORT BRAGG, CA 95437-5751
(707) 964-1208
(707) 964-2269
Mailing address
121 BOATYARD DR, STE A, FORT BRAGG, CA 95437-5751
(707) 964-1208
(707) 964-2269
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GPT001030
—
CA
Enumeration date
06/09/2005
Last updated
04/20/2008
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