Provider Demographics
NPI:1437502275
Name:PREVENTION WELLNESS AND RESTORATIVE SOLUTIONS PHYSICAL THERAPY CORP
Entity Type:Organization
Organization Name:PREVENTION WELLNESS AND RESTORATIVE SOLUTIONS PHYSICAL THERAPY CORP
Other - Org Name:PHYSIOFIXX PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST, PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:DANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, OCS
Authorized Official - Phone:858-342-9538
Mailing Address - Street 1:7429 STONEVIEW CT
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92119-1212
Mailing Address - Country:US
Mailing Address - Phone:858-342-9538
Mailing Address - Fax:
Practice Address - Street 1:7290 NAVAJO RD
Practice Address - Street 2:SUITE 111
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92119-1629
Practice Address - Country:US
Practice Address - Phone:858-342-9538
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-18
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25518261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy