Healthcare Provider Details

I. General information

NPI: 1598984213
Provider Name (Legal Business Name): VIA REAL PHYSICAL THERAPY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 07/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4180 VIA REAL SUITE C
CARPINTERIA CA
93013-1265
US

IV. Provider business mailing address

4180 VIA REAL SUITE C
CARPINTERIA CA
93013-1265
US

V. Phone/Fax

Practice location:
  • Phone: 805-566-0600
  • Fax: 805-566-0637
Mailing address:
  • Phone: 805-566-0600
  • Fax: 805-566-0637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT20274
License Number StateCA

VIII. Authorized Official

Name: WILLIAM B FISHER
Title or Position: OFFICER
Credential: PT
Phone: 805-566-0600