Provider Demographics
NPI:1093158586
Name:EXOS - ATHLETES' PERFORMANCE SAN DIEGO
Entity Type:Organization
Organization Name:EXOS - ATHLETES' PERFORMANCE SAN DIEGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, PHYSICAL THERAPY
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERI
Authorized Official - Middle Name:
Authorized Official - Last Name:WALTERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-626-4589
Mailing Address - Street 1:2081 FARADAY AVE
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-7230
Mailing Address - Country:US
Mailing Address - Phone:760-494-1570
Mailing Address - Fax:480-659-6305
Practice Address - Street 1:2081 FARADAY AVE
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-7230
Practice Address - Country:US
Practice Address - Phone:760-494-1570
Practice Address - Fax:480-659-6305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-15
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty