Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Emerald Bay Physical Therapy PC

Organization Physical Medicine & Rehabilitation Physician · NPI 1275258485

Emerald Bay Physical Therapy PC is a Physical Medicine & Rehabilitation Physician in South Lake Tahoe, California. Registered with an NPI since 2022.

In the registry since
2022
What do these letters mean?
PC — Professional corporation
A form of business registration, not a clinical qualification.

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Practice location Address checks out

812 Emerald Bay Rd
South Lake Tahoe, CA 96150-6413
Phone: (530) 542-2662
Fax: (530) 542-2661
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Medicine & Rehabilitation Physician (primary) Taxonomy 208100000X

Record details

NPI number1275258485
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Stacey Mullins — Biller/Credentialing Specialist · (530) 314-3971
NPI enumeratedOctober 10, 2022
Last updated in NPPESDecember 28, 2023
Certification dateDecember 28, 2023
Mailing address812 Emerald Bay Rd, South Lake Tahoe, CA 96150-6413

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