Provider Demographics
NPI:1467441055
Name:MONTEREY PENINSULA PHYSICAL THERAPY
Entity Type:Organization
Organization Name:MONTEREY PENINSULA PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:LAGANA
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:831-646-1100
Mailing Address - Street 1:337 EL DORADO ST
Mailing Address - Street 2:SUITE B5
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-4647
Mailing Address - Country:US
Mailing Address - Phone:831-646-1100
Mailing Address - Fax:831-646-1014
Practice Address - Street 1:337 EL DORADO ST
Practice Address - Street 2:SUITE B5
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-4647
Practice Address - Country:US
Practice Address - Phone:831-646-1100
Practice Address - Fax:831-646-1014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA97739174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT100800Medicare ID - Type UnspecifiedTONY LAGANA
CAOPT123800Medicare ID - Type UnspecifiedPAMELA THAYER
CAOPT100800Medicare ID - Type UnspecifiedANTONINO LAGANA