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Organization
SPORTS & WELLNESS PHYSICAL THERAPY, INC.
Active
Organization
SPORTS & WELLNESS PHYSICAL THERAPY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOUGLAS BRENT JOHNSON R.P.T. (OWNER/PHYSICAL THERAPIST)
(805) 439-2159
Entity
Organization
Contact information
Practice address
3440 S HIGUERA ST STE 120, SAN LUIS OBISPO, CA 93401-7393
(805) 439-2159
(805) 439-2160
Mailing address
PO BOX 3070, SHELL BEACH, CA 93448-3070
(805) 439-2159
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT14568
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GPT001450
—
CA
Enumeration date
07/14/2006
Last updated
09/13/2016
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