Provider Demographics
NPI: | 1033578281 |
---|---|
Name: | MURDOCK PHYSICAL THERAPY INC. |
Entity Type: | Organization |
Organization Name: | MURDOCK PHYSICAL THERAPY INC. |
Other - Org Name: | MURDOCK PHYSICAL THERAPY |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | DARYL |
Authorized Official - Middle Name: | LAWRENCE |
Authorized Official - Last Name: | MURDOCK |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | PT |
Authorized Official - Phone: | 619-715-5811 |
Mailing Address - Street 1: | PO BOX 21773 |
Mailing Address - Street 2: | |
Mailing Address - City: | EL CAJON |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 92021-0966 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 2163 SHIRE DR |
Practice Address - Street 2: | |
Practice Address - City: | EL CAJON |
Practice Address - State: | CA |
Practice Address - Zip Code: | 92019-2657 |
Practice Address - Country: | US |
Practice Address - Phone: | 619-715-5811 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2016-02-16 |
Last Update Date: | 2016-02-16 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | 26541 | 174400000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 174400000X | Other Service Providers | Specialist | Group - Multi-Specialty |