Healthcare Provider Details

I. General information

NPI: 1093044547
Provider Name (Legal Business Name): BELLA AND BABY PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2009
Last Update Date: 12/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4630 SOQUEL DR STE 8C
SOQUEL CA
95073-3100
US

IV. Provider business mailing address

4630 SOQUEL DR STE 8C
SOQUEL CA
95073-3100
US

V. Phone/Fax

Practice location:
  • Phone: 831-713-7457
  • Fax: 831-621-4701
Mailing address:
  • Phone: 831-713-7457
  • Fax: 831-621-4701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number35747
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number35747
License Number State

VIII. Authorized Official

Name: ADRIANA PATRICIA MESA
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: PT, MS
Phone: 831-713-7457