Healthcare Provider Details

I. General information

NPI: 1417014028
Provider Name (Legal Business Name): ALYCE MAY EWEN MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2530 PROFESSIONAL PKWY
SANTA MARIA CA
93455-8200
US

IV. Provider business mailing address

PO BOX 6450
SANTA MARIA CA
93456-6450
US

V. Phone/Fax

Practice location:
  • Phone: 805-928-4465
  • Fax: 805-928-7935
Mailing address:
  • Phone: 805-928-4465
  • Fax: 805-928-7935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT25900
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: