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Organization
ON TRACK PHYSICAL THERAPY AND PERFORMANCE, P.C.
Active
Organization
ON TRACK PHYSICAL THERAPY AND PERFORMANCE, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BLAKE PHILLIPS RUSSELL (OWNER)
(831) 917-9886
Entity
Organization
Contact information
Practice address
220 COUNTRY CLUB GATE CTR, #11, PACIFIC GROVE, CA 93950-5014
(831) 917-9886
Mailing address
309 GRANITE ST, PACIFIC GROVE, CA 93950-3219
(831) 917-9886
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
29705
CA
Other
Enumeration date
08/09/2016
Last updated
11/22/2020
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