| |
31700 Railroad Canyon Rd, Suite 1, Canyon Lake, CA 92587-9453 | |
(951) 246-2670 | |
(951) 246-2672 |
Full Name | |
---|---|
Type | Facility |
Speciality | Physical Therapist |
Location | 31700 Railroad Canyon Rd, Canyon Lake, California |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1053490557 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
225100000X | Physical Therapist | PT 9115 (California) | Primary |
Mailing Address | Practice Location Address |
---|---|
31700 Railroad Canyon Rd, Suite 1, Canyon Lake, CA 92587-9453 Ph: (951) 246-2670 | 31700 Railroad Canyon Rd, Suite 1, Canyon Lake, CA 92587-9453 Ph: (951) 246-2670 |
Mrs. Barbara Jean Stacy, PT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 31700 Railroad Canyon Rd Ste 1, Canyon Lake, CA 92587 Phone: 951-246-2670 Fax: 951-246-2672 |