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Organization
SPORT, SPINE & ORTHOPEDIC
Active
Organization
SPORT, SPINE & ORTHOPEDIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES EDWIN ST VINCENT PT (OWNER/PHYSICAL THERAPIST)
(805) 541-4717
Entity
Organization
Contact information
Practice address
862 MEINECKE AVE, SUITE 101, SAN LUIS OBISPO, CA 93405-3702
(805) 541-4714
(805) 541-4235
Mailing address
862 MEINECKE AVE, SUITE 101, SAN LUIS OBISPO, CA 93405-3702
(805) 541-4717
(805) 541-4235
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT5452
CA
225100000X
Physical Therapist
—
—
Other
Enumeration date
10/04/2006
Last updated
11/22/2011
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