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General NPI Number Information
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NPI Number | 1760793236
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Entity Type | Organization
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Legal Business Name | PHYSICAL THERAPY SPECIALISTS PTS, INC.
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Dates
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Enumeration Date | 06/29/2010
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Last Update Date | 11/05/2019
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Provider Practice Location Address
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Address Line | 271 FIVE CITIES DR
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City | PISMO BEACH
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State | CA
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Zip | 93449-3009
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Country | US
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Telephone | 805-473-7499
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Fax | 805-473-7494
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Provider Business Mailing Address
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Address Line | PO BOX 2638
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City | PISMO BEACH
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State | CA
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Zip | 93448-2638
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Country | US
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Telephone | 805-473-7499
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Fax | 805-473-7494
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Authorized Official
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Title or Position | PHYSICAL THERAPIST/OWNER
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Name | SHELLY MARIE ALLIS
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Credential | PT
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Telephone | 805-473-7499
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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 | 3295955
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License Number State | CA
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