Provider Demographics
NPI:1740424910
Name:CENTRAL COAST PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:CENTRAL COAST PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:HASKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:805-239-1202
Mailing Address - Street 1:1421 RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:PASO ROBLES
Mailing Address - State:CA
Mailing Address - Zip Code:93446-1730
Mailing Address - Country:US
Mailing Address - Phone:805-239-1202
Mailing Address - Fax:805-239-1222
Practice Address - Street 1:1421 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:PASO ROBLES
Practice Address - State:CA
Practice Address - Zip Code:93446-1730
Practice Address - Country:US
Practice Address - Phone:805-239-1202
Practice Address - Fax:805-239-1222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-30
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT17156261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy