MEDICARE: STAR PHYSICAL THERAPY OF SANTA MARIA, 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
1	261QP2000X	Physical Therapy Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ZZZ50346Y	OTHER		BLUE SHIELD OF CALIFORNIA

General Provider Information

NPI Number	:	1578758827
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STAR PHYSICAL THERAPY OF SANTA MARIA, INC.

Provider Business Mailing Address
First Line	:	1152 VIA VERDE
Second Line	:	134
City	:	SAN DIMAS
State	:	CA
Zip	:	91773-4401
Country	:	US
Telephone Number	:	626-974-5665
Fax Number	:

Provider Business Practice Location Address
First Line	:	2342 PROFESSIONAL PKWY
Second Line	:	110
City	:	SANTA MARIA
State	:	CA
Zip	:	93455-1630
Country	:	US
Telephone Number	:	805-614-0400
Fax Number	:	805-614-0500

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. PATRICK DAVID WAYLAND
Credential	:	M.P.T.
Telephone Number	:	951-966-6555

Provider Enumeration Date	:	09/10/2007
Last Update Date	:	11/01/2011

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Directions to “STAR PHYSICAL THERAPY OF SANTA MARIA, INC. ” Practice Location

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