Provider Demographics
NPI:1366025819
Name:EVEREST MOBILE PHYSICAL THERAPY CORPORATION
Entity Type:Organization
Organization Name:EVEREST MOBILE PHYSICAL THERAPY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT, DPT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LUK
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:760-209-4868
Mailing Address - Street 1:2305 HISTORIC DECATUR RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92106-6071
Mailing Address - Country:US
Mailing Address - Phone:760-209-4868
Mailing Address - Fax:
Practice Address - Street 1:2305 HISTORIC DECATUR RD STE 100
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92106-6071
Practice Address - Country:US
Practice Address - Phone:760-209-4868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-03
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy