Organization
STAR PHYSICAL THERAPY OF SANTA MARIA, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PATRICK DAVID WAYLAND M.P.T. (DIRECTOR)
(951) 966-6555
Entity
Organization
Contact information
Practice address
2342 PROFESSIONAL PKWY, 110, SANTA MARIA, CA 93455-1630
(805) 614-0400
(805) 614-0500
Mailing address
1152 VIA VERDE, 134, SAN DIMAS, CA 91773-4401
(626) 974-5665
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ50346Y
BLUE SHIELD OF CALIFORNIA
—
Enumeration date
09/10/2007
Last updated
11/01/2011
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