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Organization

PROFESSIONAL PHYSICAL THERAPY

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JULIE S REYNOLDS P.T. (P.T. / OWNER)
(209) 392-8830
Entity
Organization

Contact information

Practice address
2138 MARGUERITE ST, DOS PALOS, CA 93620-2351
(209) 392-8830
(209) 392-8830
Mailing address
2138 MARGUERITE ST, DOS PALOS, CA 93620-2351
(209) 392-8830
(209) 392-8830

Taxonomy

Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
PT18659
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
OPT186590
MEDICARE PROVIDER #
CA
Enumeration date
09/29/2011
Last updated
09/29/2011
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