Provider Demographics
NPI:1407010242
Name:SNOWVIEW PHYSICAL THERAPY
Entity Type:Organization
Organization Name:SNOWVIEW PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:B
Authorized Official - Last Name:MASHTALIER
Authorized Official - Suffix:
Authorized Official - Credentials:MPT, GCS
Authorized Official - Phone:760-868-0800
Mailing Address - Street 1:3936 PHELAN RD
Mailing Address - Street 2:STE B9
Mailing Address - City:PHELAN
Mailing Address - State:CA
Mailing Address - Zip Code:92371-4141
Mailing Address - Country:US
Mailing Address - Phone:760-868-0800
Mailing Address - Fax:760-868-0822
Practice Address - Street 1:3936 PHELAN RD
Practice Address - Street 2:STE B9
Practice Address - City:PHELAN
Practice Address - State:CA
Practice Address - Zip Code:92371-4141
Practice Address - Country:US
Practice Address - Phone:760-868-0800
Practice Address - Fax:760-868-0822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-10
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy