Provider Demographics
NPI:1144415878
Name:PHYSICALTHERAPY@HOME
Entity Type:Organization
Organization Name:PHYSICALTHERAPY@HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYISCAL THERAPY DIRECTOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:DEMPSEY
Authorized Official - Suffix:
Authorized Official - Credentials:BSC(HONS)
Authorized Official - Phone:760-644-3565
Mailing Address - Street 1:724 SUGAR PINE ST
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92058-1656
Mailing Address - Country:US
Mailing Address - Phone:760-644-3565
Mailing Address - Fax:866-269-8635
Practice Address - Street 1:724 SUGAR PINE ST
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92058-1656
Practice Address - Country:US
Practice Address - Phone:760-644-3565
Practice Address - Fax:866-269-8635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT28259225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT28259Medicare PIN