1891014510 NPI number — FOCUS PHYSICAL THERAPY, INCORPORATED

Table of content: MCKAYLA DIANE SOUCY CRMA, DSP, CNA (NPI 1982244570)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891014510 NPI number — FOCUS PHYSICAL THERAPY, INCORPORATED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOCUS PHYSICAL THERAPY, INCORPORATED
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:
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:
1891014510
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/20/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
177 VULCAN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOMPOC
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93436-1406
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-733-7500
Provider Business Mailing Address Fax Number:
805-733-7510

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
177 VULCAN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOMPOC
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93436-1406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-733-7500
Provider Business Practice Location Address Fax Number:
805-733-7510
Provider Enumeration Date:
05/20/2010

Additional Information

Authorized Official

Authorized Official Last Name:
WISWALL
Authorized Official First Name:
DANIELLE
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICAL THERAPIST
Authorized Official Telephone Number:
805-733-7500

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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