Healthcare Provider Details

I. General information

NPI: 1538192679
Provider Name (Legal Business Name): SAN LUIS PHYSICAL THERAPY & ORTHOPEDIC REHABILITATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 04/10/2023
Certification Date: 04/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 W TURNER RD STE 250
LODI CA
95242-2192
US

IV. Provider business mailing address

408 HIGUERA ST STE 200
SAN LUIS OBISPO CA
93401-6135
US

V. Phone/Fax

Practice location:
  • Phone: 209-334-2224
  • Fax: 209-334-2225
Mailing address:
  • Phone: 805-788-0805
  • Fax: 805-788-0845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: KELLY SANDERS
Title or Position: PRESIDENT
Credential: PT
Phone: 805-788-0805