Canyon Lake Physical Therapy, Inc

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT 9115 Issued in CA

Legal business name

CANYON LAKE PHYSICAL THERAPY, INC

Doing business as

Canyon Lake Physical Therapy

Practice address

31700 Railroad Canyon Rd
Suite 1
Canyon Lake, CA 92587-9453

Phone

(951) 246-2670

Fax

(951) 246-2672

NPI assigned

Nov 3, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Barbara Jean Stacy, PT, M.O.M.T.NPI 1215082581

Title

Physical Therapist, Owner

Phone

(951) 246-2670

Specialties & licenses 1

Addresses

Other names 1

• Canyon Lake Physical Therapy Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Barbara Jean Stacy, PT

  • Physical Therapist
  • Canyon Lake, CA
  • NPI 1215082581
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162512000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1053490557",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31700 RAILROAD CANYON RD",
            "address_2": "SUITE 1",
            "city": "CANYON LAKE",
            "state": "CA",
            "postal_code": "925879453",
            "telephone_number": "951-246-2670",
            "fax_number": "951-246-2672"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31700 RAILROAD CANYON RD",
            "address_2": "SUITE 1",
            "city": "CANYON LAKE",
            "state": "CA",
            "postal_code": "925879453",
            "telephone_number": "951-246-2670",
            "fax_number": "951-246-2672"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANYON LAKE PHYSICAL THERAPY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "STACY",
        "authorized_official_first_name": "BARBARA",
        "authorized_official_middle_name": "JEAN",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST, OWNER",
        "authorized_official_telephone_number": "951-246-2670",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "PT, M.O.M.T."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT 9115",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Canyon Lake Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Terri Ann Branham, MA, CCC, SP8915
• Ashleigh Brown
• Tiffany Renee Burgess
• California Medical Supply
• Canyon Consulting Group (A Mindful You)
• Casa de Lago
• Chanel Chew Castillo
• Garrett Chase
• Dawn Chatigny, LAC
• Lorna Lyanthie Conyers, PHD

• Physical Therapist in Canyon Lake, CA
• Providers in Canyon Lake, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.