Provider Demographics
NPI:1134544059
Name:IN STRIDE PHYSICAL THERAPY & REHAB, INC.
Entity type:Organization
Organization Name:IN STRIDE PHYSICAL THERAPY & REHAB, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TALLI
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN SUNDER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:831-657-0177
Mailing Address - Street 1:PO BOX 136
Mailing Address - Street 2:
Mailing Address - City:PACIFIC GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:93950-0136
Mailing Address - Country:US
Mailing Address - Phone:831-657-0177
Mailing Address - Fax:831-508-8998
Practice Address - Street 1:581 LIGHTHOUSE AVE
Practice Address - Street 2:
Practice Address - City:PACIFIC GROVE
Practice Address - State:CA
Practice Address - Zip Code:93950-2646
Practice Address - Country:US
Practice Address - Phone:831-657-0177
Practice Address - Fax:831-508-8998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-28
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225X00000X
235Z00000X
CAPT26302225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty