Provider Demographics
NPI:1972809200
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:PHYSICAL THERAPIST/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:805-462-1110
Mailing Address - Street 1:7380 MORRO RD
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-4429
Mailing Address - Country:US
Mailing Address - Phone:805-462-1110
Mailing Address - Fax:805-462-0660
Practice Address - Street 1:4070 WEST ST
Practice Address - Street 2:
Practice Address - City:CAMBRIA
Practice Address - State:CA
Practice Address - Zip Code:93428-3023
Practice Address - Country:US
Practice Address - Phone:805-927-1055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL COAST PHYSICAL THERAPY, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-02-03
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy