Provider Demographics
NPI:1376764571
Name:WEST STAR PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:WEST STAR PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:SUNDSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-827-4822
Mailing Address - Street 1:PO BOX 6209
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92846-6209
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12062 VALLEY VIEW ST STE 200
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92845-1739
Practice Address - Country:US
Practice Address - Phone:714-827-4822
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2024-04-16
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
CAW18729Medicare PIN
CAW18729AMedicare PIN
CAZZZ01671ZMedicare PIN
CAZZZ01672ZMedicare PIN