Organization
CAMPUS COMMONS PHYSICAL THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANNE LASSON (VICE PRESIDENT)
(408) 570-0510
Entity
Organization
Contact information
Practice address
1411 SECRET RAVINE, STE 100, ROSEVILLE, CA 95661
(916) 789-0262
(916) 789-0282
Mailing address
PO BOX 612260, SAN JOSE, CA 95161-2260
(877) 325-2776
(408) 945-4011
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
225XH1200X
Hand Occupational Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2211662
FIRST HEALTH
—
01
—
ZZZ06750Z
BLUE SHIELD
—
Enumeration date
11/22/2005
Last updated
09/11/2025
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