| Organization Name: | CANYON LAKE PHYSICAL THERAPY, INC |
| NPI Number: | 1053490557 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BARBARA JEAN STACY (PHYSICAL THERAPIST, OWNER) |
| Mailing Address: | 31700 Railroad Canyon Rd Suite 1 Canyon Lake |
| State: | CA US |
| Postal Code: | 925879453 |
| Phone Number: | 9512462670 |
| Fax Number: | 9512462672 |
| NPI Enumeration Date: | 11/03/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | PT 9115 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |