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General NPI Number Information
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NPI Number | 1841577210
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Entity Type | Organization
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Legal Business Name | TIP TOP SHAPE WELLNESS FITNESS AND PHYSICAL THERAPY FOUNDATION INC
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Dates
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Enumeration Date | 11/13/2011
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Last Update Date | 11/13/2011
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Provider Practice Location Address
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Address Line | 50 PENNY LN
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City | WATSONVILLE
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State | CA
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Zip | 95076-3079
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Country | US
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Telephone | 888-538-3828
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Fax |
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Provider Business Mailing Address
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Address Line | 50 PENNY LN
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City | WATSONVILLE
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State | CA
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Zip | 95076-3079
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Country | US
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Telephone | 888-538-3828
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | MS. ANNAVAL DACANAY VILLAFUERTE
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Credential | PT, GCS, CLT, WCC
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Telephone | 888-538-3828
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 32295
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License Number State | CA
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