Healthcare Provider Details

I. General information

NPI: 1437385838
Provider Name (Legal Business Name): SPECIALIZED THERAPY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2009
Last Update Date: 06/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4764 SANTA MONICA AVE
SAN DIEGO CA
92107-2209
US

IV. Provider business mailing address

4764 SANTA MONICA AVE
SAN DIEGO CA
92107-2209
US

V. Phone/Fax

Practice location:
  • Phone: 619-252-4557
  • Fax:
Mailing address:
  • Phone: 619-252-4557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number12656
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberOT CREDENTIAL #5377
License Number StateCA

VIII. Authorized Official

Name: MR. STEVEN J OAS
Title or Position: PRESIDENT
Credential: CCC-SLP
Phone: 619-252-4557