Healthcare Provider Details

I. General information

NPI: 1003671157
Provider Name (Legal Business Name): WYLLOW PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2024
Last Update Date: 02/19/2024
Certification Date: 02/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 W ANAPAMU ST STE B
SANTA BARBARA CA
93101-5151
US

IV. Provider business mailing address

2108 N ST # 7253
SACRAMENTO CA
95816-5712
US

V. Phone/Fax

Practice location:
  • Phone: 805-514-2010
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: LAURA HERGET
Title or Position: PRESIDENT
Credential: DPT
Phone: 805-514-2010