Provider Demographics
NPI:1447380290
Name:MONDRY, JOSEPH M (DPT, MSRS, CSCS, CLT)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:M
Last Name:MONDRY
Suffix:
Gender:M
Credentials:DPT, MSRS, CSCS, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 PASEO PACIFICA
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-3644
Mailing Address - Country:US
Mailing Address - Phone:760-613-6044
Mailing Address - Fax:619-934-9581
Practice Address - Street 1:2535 TRUXTUN RD STE 208
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92106-6160
Practice Address - Country:US
Practice Address - Phone:619-415-5817
Practice Address - Fax:619-934-9581
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT20030225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist