Healthcare Provider Details

I. General information

NPI: 1861876807
Provider Name (Legal Business Name): ARROYO GRANDE PHYSICAL THERAPY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2015
Last Update Date: 07/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 S HALCYON RD
ARROYO GRANDE CA
93420-3115
US

IV. Provider business mailing address

520 CARMELLA DR
ARROYO GRANDE CA
93420-3712
US

V. Phone/Fax

Practice location:
  • Phone: 805-481-5656
  • Fax:
Mailing address:
  • Phone: 805-748-7693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberAT 3833
License Number StateCA

VIII. Authorized Official

Name: CYNTHIA COESTERWHALLS
Title or Position: PTA
Credential:
Phone: 805-748-7693