Provider Demographics
NPI:1548260367
Name:SANTA MARIA VALLEY PHYSICAL THERAPY GROUP, INC.
Entity type:Organization
Organization Name:SANTA MARIA VALLEY PHYSICAL THERAPY GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:C
Authorized Official - Last Name:FYLSTRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-928-8257
Mailing Address - Street 1:820 E ENOS DR
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454
Mailing Address - Country:US
Mailing Address - Phone:805-928-8257
Mailing Address - Fax:805-349-7206
Practice Address - Street 1:820 E ENOS DR
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454
Practice Address - Country:US
Practice Address - Phone:805-928-8257
Practice Address - Fax:805-349-7206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-22
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW18217Medicare UPIN
CA5822920001Medicare NSC