Provider Demographics
NPI:1588296479
Name:WEST CLIFF PHYSICAL THERAPY
Entity type:Organization
Organization Name:WEST CLIFF PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROCHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANNAN
Authorized Official - Suffix:
Authorized Official - Credentials:MPT CLT LANA
Authorized Official - Phone:408-712-3312
Mailing Address - Street 1:214 GHARKEY ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-6104
Mailing Address - Country:US
Mailing Address - Phone:408-712-3312
Mailing Address - Fax:
Practice Address - Street 1:214 GHARKEY ST
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-6104
Practice Address - Country:US
Practice Address - Phone:408-712-3312
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEST CLIFF PHYSICAL THERAPY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-02-07
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1467595611Medicaid