MEDICARE: CV PHYSICAL THERAPY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1013167527
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CV PHYSICAL THERAPY, INC.

Provider Business Mailing Address
First Line	:	408 HIGUERA ST STE 200
Second Line	:
City	:	SAN LUIS OBISPO
State	:	CA
Zip	:	93401-6135
Country	:	US
Telephone Number	:	805-788-0805
Fax Number	:	805-544-6468

Provider Business Practice Location Address
First Line	:	81557 DR CARREON BLVD STE C4
Second Line	:
City	:	INDIO
State	:	CA
Zip	:	92201-5562
Country	:	US
Telephone Number	:	760-347-6195
Fax Number	:	760-347-2849

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. KELLY SANDERS JR.
Credential	:	DPT
Telephone Number	:	805-788-0805

Provider Enumeration Date	:	09/22/2008
Last Update Date	:	04/10/2023

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