Healthcare Provider Details

I. General information

NPI: 1285405035
Provider Name (Legal Business Name): PHASE PHYSICAL THERAPY AND WELLNESS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2024
Last Update Date: 01/10/2024
Certification Date: 01/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

566 BAKEMAN LN
ARROYO GRANDE CA
93420-3752
US

IV. Provider business mailing address

566 BAKEMAN LN
ARROYO GRANDE CA
93420-3752
US

V. Phone/Fax

Practice location:
  • Phone: 805-429-4733
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SARAH LEONG-LOPES
Title or Position: PRESIDENT
Credential: PT, DPT
Phone: 805-429-4733