1235455171 NPI number — ACTION PHYSICAL THERAPY OF SOLEDAD, INC.

Table of content: DR. TAKESHI KOMASTSU ATC., LAC., DAOM (NPI 1154423093)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235455171 NPI number — ACTION PHYSICAL THERAPY OF SOLEDAD, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACTION PHYSICAL THERAPY OF SOLEDAD, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235455171
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/16/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
359 GABILAN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOLEDAD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93960-3550
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
831-678-0516
Provider Business Mailing Address Fax Number:
831-678-0518

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
359 GABILAN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOLEDAD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93960-3550
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-678-0516
Provider Business Practice Location Address Fax Number:
831-678-0518
Provider Enumeration Date:
04/16/2010

Additional Information

Authorized Official

Authorized Official Last Name:
SCHMITZ
Authorized Official First Name:
CRAIG
Authorized Official Middle Name:
DARRYL
Authorized Official Title or Position:
OWNER/ CEO
Authorized Official Telephone Number:
831-252-8242

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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