MEDICARE: CANYON LAKE 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	225100000X	Physical Therapist	PT 9115	CA

General Provider Information

NPI Number	:	1053490557
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CANYON LAKE PHYSICAL THERAPY, INC

Provider Business Mailing Address
First Line	:	31700 RAILROAD CANYON RD
Second Line	:	SUITE 1
City	:	CANYON LAKE
State	:	CA
Zip	:	92587-9453
Country	:	US
Telephone Number	:	951-246-2670
Fax Number	:	951-246-2672

Provider Business Practice Location Address
First Line	:	31700 RAILROAD CANYON RD
Second Line	:	SUITE 1
City	:	CANYON LAKE
State	:	CA
Zip	:	92587-9453
Country	:	US
Telephone Number	:	951-246-2670
Fax Number	:	951-246-2672

Authorized Official
Title or Position	:	PHYSICAL THERAPIST, OWNER
Name	:	MRS. BARBARA JEAN STACY
Credential	:	PT, M.O.M.T.
Telephone Number	:	951-246-2670

Provider Enumeration Date	:	11/03/2006
Last Update Date	:	08/22/2020

Similar Medicare Providers

1215082581 — MRS. BARBARA JEAN STACY PT
Practice Location Address:

31700 RAILROAD CANYON RD STE 1
CANYON LAKE, CA
92587-9453

Practice Phone: 951-246-2670
Practice Fax: 951-246-2672

1700760618 — MRS. NABILLA Z. RABANI CA BBC
Practice Location Address:

31700 RAILROAD CANYON RD STE 2
CANYON LAKE, CA
92587-9453

Practice Phone: 714-312-8664
Practice Fax:

1477762870 — WALGREEN CO
Practice Location Address:

2 US 27 S
LAKE PLACID, FL
33852-9453

Practice Phone: 863-465-1178
Practice Fax:

1225137615 — DR. MICHAEL GUNNARSON DDS
Practice Location Address:

75 ARROWHEAD LN
MOOSE LAKE, MN
55767-9453

Practice Phone: 218-485-4615
Practice Fax:

1598855439 — THRIFTY DRUG STORES INC
Practice Location Address:

60 ARROWHEAD LN
MOOSE LAKE, MN
55767-9453

Practice Phone: 218-485-4401
Practice Fax: 218-485-8774

1053846808 — LYDELIZ HERNANDEZ PEREZ
Practice Location Address:

2 US HIGHWAY 27 S
LAKE PLACID, FL
33852-9453

Practice Phone: 863-465-1178
Practice Fax: 863-465-2354

Directions to “CANYON LAKE PHYSICAL THERAPY, INC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.