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
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