Organization
PREMIER SPORTS MEDICINE AND PHYSICAL THERAPY
Active
Organization
PREMIER SPORTS MEDICINE AND PHYSICAL THERAPY
Active
Other names
Premier Physical Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
ERIC INGRAM (OWNER)
(831) 457-1800
Entity
Organization
Contact information
Practice address
1003 RIVER ST, SUITE C, SANTA CRUZ, CA 95060-1754
(831) 457-1800
(831) 457-1802
Mailing address
PO BOX 3751, SANTA CRUZ, CA 95063-3751
(831) 457-1800
(831) 457-1802
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
25727
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AO096Z
PTAN
CA
Enumeration date
06/09/2008
Last updated
02/09/2009
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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