Creek Side Orthopedic

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

1813761 Issued in CA

Legal business name

CREEK SIDE ORTHOPEDIC

Practice address

1545 Higuera St
San Luis Obispo, CA 93401-2917

Phone

(805) 543-5633

Fax

(805) 543-5990

NPI assigned

Nov 29, 2005

Organization subpart

No

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

Authorized official

Name

Donald R. Olson, R.P.T.

Title

President

Phone

(805) 543-5633

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Creek side Physical Therapy Doing business as

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

{
    "created_epoch": "1133222400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1427328000000",
    "number": "1295718831",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1545 HIGUERA ST",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934012917",
            "telephone_number": "805-543-5633",
            "fax_number": "805-543-5990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1545 HIGUERA ST",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934012917",
            "telephone_number": "805-543-5633",
            "fax_number": "805-543-5990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREEK SIDE ORTHOPEDIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-29",
        "last_updated": "2015-03-26",
        "status": "A",
        "authorized_official_last_name": "OLSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "805-543-5633",
        "authorized_official_credential": "R.P.T."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "1813761",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD PIN",
            "identifier": "ZZZ40093Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Creek side Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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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 Mar 26, 2015; 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.