Provider Demographics
NPI:1912321431
Name:BECK AND CALE PHYSICAL THERAPY OF SANTA MARIA
Entity Type:Organization
Organization Name:BECK AND CALE PHYSICAL THERAPY OF SANTA MARIA
Other - Org Name:BECK AND CALE PHYSICAL THERAPY OF SANTA MARIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:CHANNER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:805-922-1724
Mailing Address - Street 1:311 JUNIPERO WAY
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-6800
Mailing Address - Country:US
Mailing Address - Phone:805-922-1724
Mailing Address - Fax:805-922-2765
Practice Address - Street 1:201 N COLLEGE DR
Practice Address - Street 2:SUITE 203
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-4614
Practice Address - Country:US
Practice Address - Phone:805-922-1724
Practice Address - Fax:805-922-2765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-05
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB221325OtherPTAN-MEDICARE