NPIMap

Organization Active NPI

San Luis Physical Therapy & Orthopedic Rehabilitation Inc

  • Physical Therapy Clinic/Center
  • San Luis Obispo, CA
National Provider Identifier
1003429416
Registry record updated Apr 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
SAN LUIS PHYSICAL THERAPY & ORTHOPEDIC REHABILITATION INC
Practice address
862 Meinecke Ave Ste 101
San Luis Obispo, CA 93405-3702
Phone
(805) 619-0414
Fax
(805) 549-5253
NPI assigned
Aug 25, 2020
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Kelly Marie Sanders, PTNPI 1316978182
Title
President
Phone
(805) 788-0805

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Other NPIs on the same Medicare enrollment 14

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Corporate family (same tax ID) 10

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners 86

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 86

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Medicare enrollment records 2

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
O20040117000206 CA Part B Supplier - Clinic/Group Practice 7618872946 Receives reassigned benefits from 85 practitioners
14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: San Luis Obispo, CA; Templeton, CA; Stockton, CA; Santa Maria, CA; Pismo Beach, CA; Paso Robles, CA; Morro Bay, CA; Lodi, CA…
O20231101001292 CA DME Supplier - Independently-Practicing Physical Therapist 7618872946 Practice locations: San Luis Obispo, CA

National Provider Directory

National Provider Directory
Tax ID family
San Luis PT Orth Rehab Inc (11 organizations share this tax ID)

Specialties & licenses 4

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X
Hand Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 2251H1200X
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X
Physical Therapy Clinic/Center 261QP2000X Primary

Addresses

NPPES NPI Registry

Primary practice location

862 Meinecke Ave Ste 101
San Luis Obispo, CA 93405-3702

Mailing address

408 Higuera St Ste 200
San Luis Obispo, CA 93401-6135
Phone (805) 788-0805

Other names 1

NPPES NPI Registry
  • Movement For Life Physical Therapy Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Apr 10, 2023.

{
    "created_epoch": "1598313600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681084800000",
    "number": "1003429416",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "408 HIGUERA ST STE 200",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934016135",
            "telephone_number": "805-788-0805",
            "fax_number": "808-788-0845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "862 MEINECKE AVE STE 101",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934053702",
            "telephone_number": "805-619-0414",
            "fax_number": "805-549-5253"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN LUIS PHYSICAL THERAPY & ORTHOPEDIC REHABILITATION INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-25",
        "last_updated": "2023-04-10",
        "certification_date": "2023-04-10",
        "status": "A",
        "authorized_official_last_name": "SANDERS",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "805-788-0805",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2251H1200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist, Hand",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Movement For Life Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Luis Obispo, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.