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General NPI Number Information
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NPI Number | 1003671157
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Entity Type | Organization
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Legal Business Name | WYLLOW PHYSICAL THERAPY INC
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Dates
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Enumeration Date | 02/19/2024
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Last Update Date | 02/19/2024
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Provider Practice Location Address
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Address Line | 25 W ANAPAMU ST STE B
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City | SANTA BARBARA
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State | CA
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Zip | 93101-5151
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Country | US
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Telephone | 805-514-2010
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Fax |
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Provider Business Mailing Address
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Address Line | 2108 N ST # 7253
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City | SACRAMENTO
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State | CA
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Zip | 95816-5712
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LAURA HERGET
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Credential | DPT
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Telephone | 805-514-2010
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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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