Healthcare Provider Details

I. General information

NPI: 1063651032
Provider Name (Legal Business Name): WELLNESS & REHABILITATION PHYSICAL THERAPY & PILATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2009
Last Update Date: 05/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7960 SOQUEL DRIVE SUITE I
APTOS CA
95003-3990
US

IV. Provider business mailing address

7960 SOQUEL DRIVE SUITE I
APTOS CA
95003-3990
US

V. Phone/Fax

Practice location:
  • Phone: 831-768-9707
  • Fax: 831-661-0296
Mailing address:
  • Phone: 831-768-9707
  • Fax: 831-661-0296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT21556
License Number StateCA

VIII. Authorized Official

Name: MRS. BECKY LOUISE SHEAFFER-EGAN
Title or Position: PHYSICAL THERAPIST, CEO
Credential: P.T.
Phone: 831-768-9707