Healthcare Provider Details

I. General information

NPI: 1285872812
Provider Name (Legal Business Name): FWTW INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2009
Last Update Date: 02/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 QUINTANA RD
MORRO BAY CA
93442-1938
US

IV. Provider business mailing address

500 QUINTANA RD
MORRO BAY CA
93442-1938
US

V. Phone/Fax

Practice location:
  • Phone: 805-772-7358
  • Fax: 805-772-0409
Mailing address:
  • Phone: 805-772-7358
  • Fax: 805-772-0409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT12081
License Number StateCA

VIII. Authorized Official

Name: MR. ROSS JOSEPH DOVER
Title or Position: CEO
Credential: PT
Phone: 805-772-7358