Healthcare Provider Details

I. General information

NPI: 1134544059
Provider Name (Legal Business Name): IN STRIDE PHYSICAL THERAPY & REHAB, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2014
Last Update Date: 03/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

581 LIGHTHOUSE AVE
PACIFIC GROVE CA
93950-2646
US

IV. Provider business mailing address

PO BOX 136
PACIFIC GROVE CA
93950-0136
US

V. Phone/Fax

Practice location:
  • Phone: 831-657-0177
  • Fax: 831-508-8998
Mailing address:
  • Phone: 831-657-0177
  • Fax: 831-508-8998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT26302
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: TALLI VAN SUNDER
Title or Position: PRESIDENT
Credential: DPT
Phone: 831-657-0177