Provider Demographics
NPI:1134318975
Name:STERLING PROVIDER SERVICES INC.
Entity Type:Organization
Organization Name:STERLING PROVIDER SERVICES INC.
Other - Org Name:STERLING PHYSICAL THERAPY AND AQUATICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:LAFRENIERE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-823-8200
Mailing Address - Street 1:2315 KUEHNER DR
Mailing Address - Street 2:#115
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-3900
Mailing Address - Country:US
Mailing Address - Phone:805-823-8200
Mailing Address - Fax:
Practice Address - Street 1:2315 KUEHNER DR
Practice Address - Street 2:#115
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-3900
Practice Address - Country:US
Practice Address - Phone:805-823-8200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW21777Medicare PIN