Healthcare Provider Details

I. General information

NPI: 1356012413
Provider Name (Legal Business Name): PENINSULA SPORT PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2021
Last Update Date: 11/17/2021
Certification Date: 11/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26625 CARMEL CENTER PL STE 200
CARMEL CA
93923-8689
US

IV. Provider business mailing address

360 MARTIN ST
MONTEREY CA
93940-4434
US

V. Phone/Fax

Practice location:
  • Phone: 831-622-0599
  • Fax:
Mailing address:
  • Phone: 831-402-2606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER TONINI
Title or Position: CEO
Credential: DPT
Phone: 831-402-2606