Provider Demographics
NPI:1700943875
Name:ANACAYA PHYSICAL THERAPY, INC
Entity Type:Organization
Organization Name:ANACAYA PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST, OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CALVIN
Authorized Official - Middle Name:T
Authorized Official - Last Name:ANACAYA
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:951-737-1328
Mailing Address - Street 1:1365 STEIN WAY
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-6063
Mailing Address - Country:US
Mailing Address - Phone:951-737-1328
Mailing Address - Fax:951-848-0564
Practice Address - Street 1:1365 STEIN WAY
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-6063
Practice Address - Country:US
Practice Address - Phone:951-737-1328
Practice Address - Fax:951-848-0564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT258202251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatricsGroup - Single Specialty