Charles E St. Vincent, P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT5452 Issued in CA

Practice address

862 Meinecke Ave
Ste. 101
San Luis Obispo, CA 93405-1721

Phone

(805) 541-4717

Fax

(805) 541-4235

NPI assigned

Oct 17, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1073693586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 CHUPARROSA DR",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934017411",
            "telephone_number": "805-541-4717",
            "fax_number": "805-541-4235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "862 MEINECKE AVE",
            "address_2": "STE. 101",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934051721",
            "telephone_number": "805-541-4717",
            "fax_number": "805-541-4235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ST. VINCENT",
        "first_name": "CHARLES",
        "middle_name": "E",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-17",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT5452",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in San Luis Obispo, CA
• Providers in San Luis Obispo, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.