Provider Demographics
NPI:1194892570
Name:BAY PHYSICAL THERAPY AND SPORTS REHABILITATION CENTER, INC.
Entity type:Organization
Organization Name:BAY PHYSICAL THERAPY AND SPORTS REHABILITATION CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:KROOPF
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:831-594-5559
Mailing Address - Street 1:500 LIGHTHOUSE AVE STE B
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-1423
Mailing Address - Country:US
Mailing Address - Phone:831-375-5909
Mailing Address - Fax:831-375-7259
Practice Address - Street 1:500 LIGHTHOUSE AVE STE B
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-1423
Practice Address - Country:US
Practice Address - Phone:831-375-5909
Practice Address - Fax:831-375-7259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ22376ZMedicare UPIN
CAZZZ22376ZMedicare PIN