Provider Demographics
NPI:1366446601
Name:JOSEPH, BRENT P (PT)
Entity Type:Individual
Prefix:MR
First Name:BRENT
Middle Name:P
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5395 RUFFIN RD
Mailing Address - Street 2:STE 201
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1338
Mailing Address - Country:US
Mailing Address - Phone:800-219-4419
Mailing Address - Fax:
Practice Address - Street 1:44274 GEORGE CUSHMAN CT
Practice Address - Street 2:STE 201
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-5945
Practice Address - Country:US
Practice Address - Phone:951-506-5959
Practice Address - Fax:951-506-5955
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT28263225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT282630OtherBLUE SHIELD
CAOPT282630OtherBLUE SHIELD
CAWPT28263AMedicare ID - Type Unspecified