Provider Demographics
NPI:1578704045
Name:SAN MATEO PHYSICAL THERAPY CENTER
Entity Type:Organization
Organization Name:SAN MATEO PHYSICAL THERAPY CENTER
Other - Org Name:CAMPUS PHYSICAL THERAPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LUIS ARANEDA
Authorized Official - Middle Name:E
Authorized Official - Last Name:ARANEDA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:650-994-7800
Mailing Address - Street 1:901 CAMPUS DR
Mailing Address - Street 2:213
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-4900
Mailing Address - Country:US
Mailing Address - Phone:650-994-7800
Mailing Address - Fax:650-240-1834
Practice Address - Street 1:101 S SAN MATEO DR
Practice Address - Street 2:200
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-3819
Practice Address - Country:US
Practice Address - Phone:650-994-7800
Practice Address - Fax:650-240-1834
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAMPUS PHYSICAL THERAPY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-13
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ04850ZOtherMEDICARE PTAN