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General NPI Number Information
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NPI Number | 1003429416
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Entity Type | Organization
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Legal Business Name | SAN LUIS PHYSICAL THERAPY & ORTHOPEDIC REHABILITATION INC
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Dates
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Enumeration Date | 08/25/2020
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Last Update Date | 04/10/2023
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Provider Practice Location Address
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Address Line | 862 MEINECKE AVE STE 101
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93405-3702
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Country | US
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Telephone | 805-619-0414
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Fax | 805-549-5253
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Provider Business Mailing Address
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Address Line | 408 HIGUERA ST STE 200
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-6135
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Country | US
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Telephone | 805-788-0805
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Fax | 808-788-0845
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Authorized Official
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Title or Position | PRESIDENT
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Name | KELLY MARIE SANDERS
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Credential | PT
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Telephone | 805-788-0805
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2251H1200X
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Taxonomy Name | Hand Physical Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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