Provider Demographics
NPI:1275553034
Name:SUNRISE PHYSICAL THERAPY SERVICES, INC
Entity Type:Organization
Organization Name:SUNRISE PHYSICAL THERAPY SERVICES, INC
Other - Org Name:NONE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:LYNNETTE
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:805-644-1273
Mailing Address - Street 1:2296 CHELSEY CT
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-1160
Mailing Address - Country:US
Mailing Address - Phone:805-482-9565
Mailing Address - Fax:
Practice Address - Street 1:705 N OXNARD BLVD STE 107
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-4314
Practice Address - Country:US
Practice Address - Phone:805-983-0811
Practice Address - Fax:805-983-1481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 155952251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14955AMedicare ID - Type UnspecifiedPROVIDER NUMBER
CAW14955Medicare ID - Type UnspecifiedPROVIDER NUMBER