Organization
CAMPUS COMMONS PHYSICAL THERAPY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK D EDDY P.T. (OWNER)
(916) 927-1333
Entity
Organization
Contact information
Practice address
601 UNIVERSITY AVE STE 185, SACRAMENTO, CA 95825-6739
(916) 927-1333
(916) 927-1586
Mailing address
601 UNIVERSITY AVE STE 185, SACRAMENTO, CA 95825-6739
(916) 927-1333
(916) 927-1586
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
225X00000X
Occupational Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
197554800
DOL
—
01
—
5318800
CIGNA
CA
01
—
DA1522
RAILROAD
CA
01
—
ZZZ03086Z
BLUE SHIELD
—
Enumeration date
11/18/2005
Last updated
11/27/2017
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