Healthcare Provider Details

I. General information

NPI: 1740424910
Provider Name (Legal Business Name): CENTRAL COAST PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2009
Last Update Date: 08/17/2021
Certification Date: 08/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 RIVERSIDE AVE
PASO ROBLES CA
93446-1730
US

IV. Provider business mailing address

1421 RIVERSIDE AVE
PASO ROBLES CA
93446-1730
US

V. Phone/Fax

Practice location:
  • Phone: 805-239-1202
  • Fax: 805-239-1222
Mailing address:
  • Phone: 805-239-1202
  • Fax: 805-239-1222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT17156
License Number StateCA

VIII. Authorized Official

Name: LEE HASKIN
Title or Position: OWNER
Credential: DPT
Phone: 805-239-1202