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General NPI Number Information
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NPI Number | 1134544059
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Entity Type | Organization
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Legal Business Name | IN STRIDE PHYSICAL THERAPY & REHAB, INC.
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Dates
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Enumeration Date | 02/28/2014
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Last Update Date | 03/27/2017
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Provider Practice Location Address
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Address Line | 581 LIGHTHOUSE AVE
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City | PACIFIC GROVE
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State | CA
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Zip | 93950-2646
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Country | US
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Telephone | 831-657-0177
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Fax | 831-508-8998
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Provider Business Mailing Address
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Address Line | PO BOX 136
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City | PACIFIC GROVE
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State | CA
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Zip | 93950-0136
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Country | US
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Telephone | 831-657-0177
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Fax | 831-508-8998
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Authorized Official
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Title or Position | PRESIDENT
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Name | TALLI VAN SUNDER
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Credential | DPT
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Telephone | 831-657-0177
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | CA
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT26302
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License Number State | CA
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