Provider Demographics
NPI:1295464675
Name:BASE CAMP PHYSICAL THERAPY
Entity Type:Organization
Organization Name:BASE CAMP PHYSICAL THERAPY
Other - Org Name:BASE CAMP PT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:TAKAOKA-MARTINEAU
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:626-375-8445
Mailing Address - Street 1:13521 CORRAL CT
Mailing Address - Street 2:
Mailing Address - City:VALLEY CENTER
Mailing Address - State:CA
Mailing Address - Zip Code:92082-6971
Mailing Address - Country:US
Mailing Address - Phone:626-375-8445
Mailing Address - Fax:
Practice Address - Street 1:29105 VALLEY CENTER RD STE 150
Practice Address - Street 2:
Practice Address - City:VALLEY CENTER
Practice Address - State:CA
Practice Address - Zip Code:92082-6536
Practice Address - Country:US
Practice Address - Phone:626-375-8445
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-09
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy