Provider Demographics
NPI:1114034576
Name:WCPT INC
Entity Type:Organization
Organization Name:WCPT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:D
Authorized Official - Last Name:BRADY
Authorized Official - Suffix:
Authorized Official - Credentials:MBA CHE
Authorized Official - Phone:619-368-4855
Mailing Address - Street 1:374 H ST
Mailing Address - Street 2:STE 102
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-5547
Mailing Address - Country:US
Mailing Address - Phone:619-691-0345
Mailing Address - Fax:619-691-0131
Practice Address - Street 1:1265 AVOCADO AVE
Practice Address - Street 2:104-197
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-7783
Practice Address - Country:US
Practice Address - Phone:619-368-4855
Practice Address - Fax:619-390-8312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW20341Medicare ID - Type Unspecified