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NPI Code Detail

MEDICARE: ALTA ORTHOPAEDIC MEDICAL GROUP, INC.

MEDICARE: ALTA ORTHOPAEDIC MEDICAL GROUP, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QP2000XPhysical Therapy Clinic/CenterPT12281CA

General Provider Information

NPI Number : 1477749315
Entity Type Code : Organization
Provider Name (Legal Business Name) : ALTA ORTHOPAEDIC MEDICAL GROUP, INC.
Provider Business Mailing Address
First Line : 511 BATH ST
Second Line :
City : SANTA BARBARA
State : CA
Zip : 93101-3403
Country : US
Telephone Number : 805-963-9377
Fax Number : 805-962-2154
Provider Business Practice Location Address
First Line : 511 BATH ST
Second Line :
City : SANTA BARBARA
State : CA
Zip : 93101-3403
Country : US
Telephone Number : 805-963-9377
Fax Number : 805-962-2154
Authorized Official
Title or Position : ADMINISTRATOR
Name : MR. STEPHEN ALEN KENT
Credential : M.H.A.
Telephone Number : 805-963-9377
Provider Enumeration Date : 09/24/2007
Last Update Date : 09/24/2007

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