Provider Demographics
NPI:1902132012
Name:ADVANCED INTEGRATIVE REHABILITATION
Entity Type:Organization
Organization Name:ADVANCED INTEGRATIVE REHABILITATION
Other - Org Name:FYZICAL SANTA CRUZ
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST/ PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:VAFIADES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-346-6886
Mailing Address - Street 1:1200 41ST AVE STE H
Mailing Address - Street 2:
Mailing Address - City:CAPITOLA
Mailing Address - State:CA
Mailing Address - Zip Code:95010-3900
Mailing Address - Country:US
Mailing Address - Phone:831-346-6886
Mailing Address - Fax:831-346-6884
Practice Address - Street 1:1200 41ST AVE STE H
Practice Address - Street 2:
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010-3900
Practice Address - Country:US
Practice Address - Phone:831-346-6886
Practice Address - Fax:831-346-6884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-23
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35404261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy