Provider Demographics
NPI:1578860748
Name:TICE VALLEY PHYSCIAL THERAPY INC.
Entity type:Organization
Organization Name:TICE VALLEY PHYSCIAL THERAPY INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:DENDINGER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:925-935-0510
Mailing Address - Street 1:1874 TICE VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94595-2224
Mailing Address - Country:US
Mailing Address - Phone:925-935-0510
Mailing Address - Fax:925-935-0750
Practice Address - Street 1:101 YGNACIO VALLEY RD STE 400
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-4087
Practice Address - Country:US
Practice Address - Phone:925-935-0510
Practice Address - Fax:925-935-0750
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TICE VALLEY PHYSICAL THERAPY INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-02-23
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT21277261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy