Healthcare Provider Details

I. General information

NPI: 1881928893
Provider Name (Legal Business Name): STONEMOUNTAIN PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2009
Last Update Date: 03/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21628 GOLDEN STAR BLVD
TEHACHAPI CA
93561-8607
US

IV. Provider business mailing address

21628 GOLDEN STAR BLVD
TEHACHAPI CA
93561-8607
US

V. Phone/Fax

Practice location:
  • Phone: 661-823-8101
  • Fax: 661-823-8108
Mailing address:
  • Phone: 661-823-8101
  • Fax: 661-823-8108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberPT3215
License Number StateCA

VIII. Authorized Official

Name: DANIEL L STEINBERG
Title or Position: OWNER
Credential: P.T.
Phone: 661-823-8101