Provider Demographics
NPI:1275015042
Name:WOMEN'S HEALTH PHYSICAL THERAPY SERVICES PC
Entity Type:Organization
Organization Name:WOMEN'S HEALTH PHYSICAL THERAPY SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:BETTINA
Authorized Official - Last Name:GRUBB
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:619-866-8494
Mailing Address - Street 1:805 HOLLOWBROOK CT
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-0920
Mailing Address - Country:US
Mailing Address - Phone:619-866-8494
Mailing Address - Fax:
Practice Address - Street 1:805 HOLLOWBROOK CT
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-0920
Practice Address - Country:US
Practice Address - Phone:619-866-8494
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-29
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT20419261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy