Canyon Lake Physical Therapy, INC

NPI #1053490557 in Canyon Lake, California

Provider Information

NPI Number: 1053490557
Entity Type: Organization
Organization Name: Canyon Lake Physical Therapy, INC
Primary Specialty: Physical Therapist
Enumeration Date: Nov 3, 2006
Last Updated: Aug 22, 2020

Practice Location

Address: 31700 RAILROAD CANYON RD
Address 2: SUITE 1
City: Canyon Lake
State: California
ZIP Code: 92587-9453
Phone: (951) 246-2670

Authorized Official

Name: MRS. BARBARA JEAN STACY, PT, M.O.M.T.
Title: PHYSICAL THERAPIST, OWNER
Phone: (951) 246-2670

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physical Therapist	225100000X	Primary

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