Healthcare Provider Details

I. General information

NPI: 1902339989
Provider Name (Legal Business Name): SANDY BARIL B.SC.PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2017
Last Update Date: 04/06/2017
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

581 LIGHTHOUSE AVE
PACIFIC GROVE CA
93950-2646
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT291495
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: