Provider Demographics
NPI:1861518466
Name:WEST COAST PHYSICAL THERAPY AND SPORTS MEDICINE
Entity type:Organization
Organization Name:WEST COAST PHYSICAL THERAPY AND SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:805-983-3819
Mailing Address - Street 1:451 W GONZALES RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-9004
Mailing Address - Country:US
Mailing Address - Phone:805-983-3819
Mailing Address - Fax:
Practice Address - Street 1:451 W GONZALES RD
Practice Address - Street 2:SUITE 120
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-9004
Practice Address - Country:US
Practice Address - Phone:805-983-3819
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherTAX ID #
CAPT11485Medicare ID - Type Unspecified