Provider Demographics
NPI:1467436329
Name:CALIFORNIA SPORTS PHYSICAL THERAPY CENTERS, INC.
Entity Type:Organization
Organization Name:CALIFORNIA SPORTS PHYSICAL THERAPY CENTERS, INC.
Other - Org Name:CYPRESS COAST PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:PACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-804-1712
Mailing Address - Street 1:2035 CORTE DEL NOGAL STE 200
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-1445
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 WILSON RD STE C
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-7864
Practice Address - Country:US
Practice Address - Phone:831-375-1885
Practice Address - Fax:831-375-7436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-05
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4435160OtherAETNA
CA183888000OtherDOL
CA1173851OtherCIGNA
CAC16964OtherRAILROAD
CAZZZ66185ZOtherBLUESHIELD
CAC16964OtherRAILROAD