Healthcare Provider Details

I. General information

NPI: 1275553034
Provider Name (Legal Business Name): SUNRISE PHYSICAL THERAPY SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 09/24/2020
Certification Date: 09/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 N OXNARD BLVD STE 107
OXNARD CA
93030-4314
US

IV. Provider business mailing address

2296 CHELSEY CT
CAMARILLO CA
93010-1160
US

V. Phone/Fax

Practice location:
  • Phone: 805-983-0811
  • Fax: 805-983-1481
Mailing address:
  • Phone: 805-482-9565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT 15595
License Number StateCA

VIII. Authorized Official

Name: MS. JAMIE LYNNETTE MASON
Title or Position: PHYSICAL THERAPIST/OWNER
Credential: PT
Phone: 805-644-1273