Organization
ACTIVE PHYSICAL THERAPY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JORDAN ALBRIGHT LARSON P.T., O.C.S. (VICE PRESIDENT)
(805) 934-0663
Entity
Organization
Contact information
Practice address
1105 E FOSTER RD STE B, SANTA MARIA, CA 93455-6400
(805) 934-0663
Mailing address
247 SANTA FE AVE, PISMO BEACH, CA 93449-1948
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
PT 21537
CA
Other
Enumeration date
11/14/2006
Last updated
08/22/2020
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