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General NPI Number Information
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NPI Number | 1245283720
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Entity Type | Organization
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Legal Business Name | ARROYO GRANDE PHYSICAL THERAPY
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 10/11/2007
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Provider Practice Location Address
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Address Line | 117 SO HALCYON ROAD
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City | ARROYO GRANDE
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State | CA
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Zip | 93420-3115
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Country | US
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Telephone | 805-481-5656
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Fax | 805-481-5749
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Provider Business Mailing Address
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Address Line | 117 SO HALCYON ROAD
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City | ARROYO GRANDE
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State | CA
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Zip | 93420-3115
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Country | US
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Telephone | 805-481-5656
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Fax | 805-481-5749
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Authorized Official
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Title or Position | PT OWNER
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Name | MR. PATRICK JOHN FORD
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Credential | PT
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Telephone | 805-481-5656
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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 | PT6466
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License Number State | CA
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