Provider Demographics
NPI:1467997965
Name:LODGE, CARA (PT)
Entity Type:Individual
Prefix:MS
First Name:CARA
Middle Name:
Last Name:LODGE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10836 CAMINITO COLORADO
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-3554
Mailing Address - Country:US
Mailing Address - Phone:520-609-3689
Mailing Address - Fax:
Practice Address - Street 1:10836 CAMINITO COLORADO
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-3554
Practice Address - Country:US
Practice Address - Phone:520-609-3689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-20
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT39836225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist