Provider Demographics
NPI:1841577210
Name:TIP TOP SHAPE WELLNESS FITNESS AND PHYSICAL THERAPY FOUNDATION INC
Entity Type:Organization
Organization Name:TIP TOP SHAPE WELLNESS FITNESS AND PHYSICAL THERAPY FOUNDATION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNAVAL
Authorized Official - Middle Name:DACANAY
Authorized Official - Last Name:VILLAFUERTE
Authorized Official - Suffix:
Authorized Official - Credentials:PT, GCS, CLT, WCC
Authorized Official - Phone:888-538-3828
Mailing Address - Street 1:50 PENNY LN
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-3079
Mailing Address - Country:US
Mailing Address - Phone:888-538-3828
Mailing Address - Fax:
Practice Address - Street 1:50 PENNY LN
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-3079
Practice Address - Country:US
Practice Address - Phone:888-538-3828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-13
Last Update Date:2011-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32295261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy