Provider Demographics
NPI:1245391937
Name:CAMBRIA COMMUNITY REHABILITATION, INC.
Entity Type:Organization
Organization Name:CAMBRIA COMMUNITY REHABILITATION, INC.
Other - Org Name:PELVIC THERAPY PARTNERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, OWNER, PT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERI
Authorized Official - Middle Name:LYNETTE
Authorized Official - Last Name:BALDWIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:805-924-1605
Mailing Address - Street 1:3421 EMPRESA DRIVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-2820
Mailing Address - Country:US
Mailing Address - Phone:805-783-2390
Mailing Address - Fax:805-783-2402
Practice Address - Street 1:3421 EMPRESA DR STE D
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-7364
Practice Address - Country:US
Practice Address - Phone:805-783-2390
Practice Address - Fax:805-783-2402
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAMBRIA COMMUNITY REHABILITATION, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT17498225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT174980OtherBLUE SHIELD ID NUMBER
CAPT017498Medicaid
CAPT0174980OtherRAIL ROAD MEDICARE ID #
CAPT0174980OtherRAIL ROAD MEDICARE ID #