Provider Demographics
NPI:1285829374
Name:GASPAR PHYSICAL THERAPY
Entity Type:Organization
Organization Name:GASPAR PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ATHLETIC TRAINER
Authorized Official - Prefix:MR
Authorized Official - First Name:CRISTOPHER
Authorized Official - Middle Name:AUGUST
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:ATC
Authorized Official - Phone:858-692-3437
Mailing Address - Street 1:7760 EL CAMINO REAL
Mailing Address - Street 2:STE A
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-0000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7760 EL CAMINO REAL
Practice Address - Street 2:STE A
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-8553
Practice Address - Country:US
Practice Address - Phone:760-634-9750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare