Organization
CANYON LAKE PHYSICAL THERAPY, INC
Active
Other names
Canyon Lake Physical Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BARBARA JEAN STACY PT, M.O.M.T. (PHYSICAL THERAPIST, OWNER)
(951) 246-2670
Entity
Organization
Contact information
Practice address
31700 RAILROAD CANYON RD, SUITE 1, CANYON LAKE, CA 92587-9453
(951) 246-2670
(951) 246-2672
Mailing address
31700 RAILROAD CANYON RD, SUITE 1, CANYON LAKE, CA 92587-9453
(951) 246-2670
(951) 246-2672
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT 9115
CA
Other
Enumeration date
11/03/2006
Last updated
08/22/2020
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