Provider Demographics
NPI:1609414416
Name:PASO ROBLES PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:PASO ROBLES PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:805-237-0272
Mailing Address - Street 1:5255 EL CAMINO REAL STE C
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-3351
Mailing Address - Country:US
Mailing Address - Phone:805-237-0272
Mailing Address - Fax:
Practice Address - Street 1:5255 EL CAMINO REAL STE C
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-3351
Practice Address - Country:US
Practice Address - Phone:805-237-0272
Practice Address - Fax:805-237-2416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-12
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty