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General NPI Number Information
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NPI Number | 1104262351
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Entity Type | Organization
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Legal Business Name | CV PHYSICAL THERAPY INC
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Dates
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Enumeration Date | 05/15/2013
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Last Update Date | 02/28/2018
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Provider Practice Location Address
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Address Line | 1350 41ST AVE STE 100
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City | CAPITOLA
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State | CA
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Zip | 95010-3934
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Country | US
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Telephone | 831-706-2085
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Fax | 831-417-3799
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Provider Business Mailing Address
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Address Line | 1106 WALNUT ST SUITE 110
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-2416
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Country | US
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Telephone | 805-788-0805
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Fax | 805-788-0845
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Authorized Official
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Title or Position | PRESIDENT
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Name | KELLY SANDER
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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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