Provider Demographics
NPI:1376798207
Name:EHRENBORG, JOANNA F (PT)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:F
Last Name:EHRENBORG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JOANNE
Other - Middle Name:
Other - Last Name:EHRENBORG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:4595 CONTOUR BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-3419
Mailing Address - Country:US
Mailing Address - Phone:781-866-1281
Mailing Address - Fax:
Practice Address - Street 1:4595 CONTOUR BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-3419
Practice Address - Country:US
Practice Address - Phone:781-866-1281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17864225100000X
CA43617225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT436172OtherBLUE SHIELD
MA110085285AMedicaid