Healthcare Provider Details

I. General information

NPI: 1811150311
Provider Name (Legal Business Name): CV PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 04/10/2023
Certification Date: 04/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1716 W HAMMER LN
STOCKTON CA
95209-2922
US

IV. Provider business mailing address

408 HIGUERA ST STE 200
SAN LUIS OBISPO CA
93401-6135
US

V. Phone/Fax

Practice location:
  • Phone: 209-473-2383
  • Fax: 209-473-1350
Mailing address:
  • Phone: 805-788-0805
  • Fax: 805-544-6468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. KELLY SANDERS
Title or Position: PRESIDENT
Credential: DPT
Phone: 805-788-0805