Provider Demographics
NPI:1164668141
Name:OUTCOMES PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:OUTCOMES PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:BASA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:760-687-3541
Mailing Address - Street 1:5255 WILLOW WALK RD
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92057-1925
Mailing Address - Country:US
Mailing Address - Phone:760-687-3541
Mailing Address - Fax:760-529-9292
Practice Address - Street 1:760 WASHBURN AVE
Practice Address - Street 2:STE 2
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-3303
Practice Address - Country:US
Practice Address - Phone:951-371-1233
Practice Address - Fax:951-371-1273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-23
Last Update Date:2009-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT28665261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1972671360OtherNPI PERSONAL
CA1972671360OtherNPI PERSONAL