Provider Demographics
NPI:1417928425
Name:FEUERBORN, PAUL JOSEPH (PT)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:JOSEPH
Last Name:FEUERBORN
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 1:1225 SUNNYCREST AVE
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-1212
Mailing Address - Country:US
Mailing Address - Phone:805-642-3778
Mailing Address - Fax:
Practice Address - Street 1:2895 LOMA VISTA RD
Practice Address - Street 2:SUITE B
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-1572
Practice Address - Country:US
Practice Address - Phone:805-643-4093
Practice Address - Fax:805-643-8401
Is Sole Proprietor?:No
Enumeration Date:2006-01-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT103112251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic