Provider Demographics
NPI:1063651032
Name:WELLNESS & REHABILITATION PHYSICAL THERAPY & PILATES
Entity Type:Organization
Organization Name:WELLNESS & REHABILITATION PHYSICAL THERAPY & PILATES
Other - Org Name:WELLHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST, CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:SHEAFFER-EGAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:831-768-9707
Mailing Address - Street 1:7960 SOQUEL DRIVE
Mailing Address - Street 2:SUITE I
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-3990
Mailing Address - Country:US
Mailing Address - Phone:831-768-9707
Mailing Address - Fax:831-661-0296
Practice Address - Street 1:7960 SOQUEL DRIVE
Practice Address - Street 2:SUITE I
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003-3990
Practice Address - Country:US
Practice Address - Phone:831-768-9707
Practice Address - Fax:831-661-0296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-13
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT21556261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00377324OtherRAILROAD MEDICARE
CA0PT215561Medicare UPIN