| NPI | 1679236566 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TREVINE ROSHAN ALBERT Medical Director 916-225-6888 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports |
| Enumeration Date | 2021-10-18 |
| Last Update Date | 2021-10-18 |