Organization
SPORT & REHAB PHYSICAL THERAPY INCORPORATED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SCOTT RUSSELL (OWNER/PHYSICAL THERAPIST)
(209) 827-6178
Entity
Organization
Contact information
Practice address
312 W J ST, LOS BANOS, CA 93635-4069
(209) 827-6178
(209) 827-6179
Mailing address
312 W J ST, LOS BANOS, CA 93635-4069
(209) 827-6178
(209) 827-6179
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
PT23597
CA
Other
Enumeration date
10/09/2008
Last updated
07/19/2024
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