Provider Demographics
NPI:1003241738
Name:MCINTIRE, SEAN S (DPT)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:S
Last Name:MCINTIRE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:317 N EL CAMINO REAL
Mailing Address - Street 2:#210
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-2811
Mailing Address - Country:US
Mailing Address - Phone:858-587-8669
Mailing Address - Fax:858-587-8675
Practice Address - Street 1:4435 EASTGATE MALL
Practice Address - Street 2:#120
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1982
Practice Address - Country:US
Practice Address - Phone:858-587-8669
Practice Address - Fax:858-587-8675
Is Sole Proprietor?:No
Enumeration Date:2013-09-12
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPT 40369225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB207618Medicare PIN