Provider Demographics
NPI:1689423758
Name:HEART OF GOLD PHYSICAL THERAPY, INC.
Entity type:Organization
Organization Name:HEART OF GOLD PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:FOLSOM,
Authorized Official - Last Name:FOLSOM
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:805-840-9407
Mailing Address - Street 1:55 HITCHCOCK WAY STE 213
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-6176
Mailing Address - Country:US
Mailing Address - Phone:805-840-9407
Mailing Address - Fax:
Practice Address - Street 1:55 HITCHCOCK WAY STE 213
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-6176
Practice Address - Country:US
Practice Address - Phone:805-840-9407
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty