Provider Demographics
NPI:1992021174
Name:ST. MARYPT CORP
Entity Type:Organization
Organization Name:ST. MARYPT CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHYSICAL THERAPY
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:MESIH
Authorized Official - Last Name:AZIZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:760-340-3255
Mailing Address - Street 1:36919 COOK STREET
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211
Mailing Address - Country:US
Mailing Address - Phone:760-340-3255
Mailing Address - Fax:760-452-5335
Practice Address - Street 1:36919 COOK STREET
Practice Address - Street 2:SUITE 102
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211
Practice Address - Country:US
Practice Address - Phone:760-340-3255
Practice Address - Fax:760-452-5335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-13
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
CAPT15402225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty