Provider Demographics
NPI:1336991546
Name:SANTA CRUZ MOBILE PHYSICAL THERAPY & WELLNESS
Entity Type:Organization
Organization Name:SANTA CRUZ MOBILE PHYSICAL THERAPY & WELLNESS
Other - Org Name:SANTA CRUZ MOBILE PT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CEO/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:831-331-0812
Mailing Address - Street 1:975 LEY ROAD
Mailing Address - Street 2:
Mailing Address - City:FELTON
Mailing Address - State:CA
Mailing Address - Zip Code:95018
Mailing Address - Country:US
Mailing Address - Phone:831-331-0812
Mailing Address - Fax:
Practice Address - Street 1:975 LEY ROAD
Practice Address - Street 2:
Practice Address - City:FELTON
Practice Address - State:CA
Practice Address - Zip Code:95018
Practice Address - Country:US
Practice Address - Phone:831-331-0812
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-02
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty