Provider Demographics
NPI:1336472703
Name:PACE, DAVID RAYMOND (DAVID PACE, PT)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:RAYMOND
Last Name:PACE
Suffix:
Gender:M
Credentials:DAVID PACE, PT
Other - Prefix:MR
Other - First Name:DAVID
Other - Middle Name:
Other - Last Name:PACE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DAVID PACE, PT
Mailing Address - Street 1:231 AVENIDA MONTEREY APT 11
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-4183
Mailing Address - Country:US
Mailing Address - Phone:831-246-0415
Mailing Address - Fax:
Practice Address - Street 1:231 AVENIDA MONTEREY APT 11
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-4183
Practice Address - Country:US
Practice Address - Phone:831-246-0415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-16
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA149292251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA22Medicare PIN