Organization
STAR PHYSICAL THERAPY OF SANTA MARIA, INC.
Active
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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