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General NPI Number Information
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NPI Number | 1578354239
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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 | 05/13/2025
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | 534 E PINE ST STE A
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City | STOCKTON
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State | CA
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Zip | 95204-5536
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Country | US
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Telephone | 209-425-4071
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Fax | 209-451-5687
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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 | 805-788-0845
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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 |
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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 | 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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