Provider Demographics
NPI:1477582542
Name:BRYAN SCHMIDT PHYSICAL THERAPY, INC
Entity Type:Organization
Organization Name:BRYAN SCHMIDT PHYSICAL THERAPY, INC
Other - Org Name:GOLDEN TRIANGLE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:PT, CHT
Authorized Official - Phone:858-677-9700
Mailing Address - Street 1:4150 REGENTS PARK ROW
Mailing Address - Street 2:#345
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-9102
Mailing Address - Country:US
Mailing Address - Phone:858-677-9700
Mailing Address - Fax:858-677-9770
Practice Address - Street 1:4150 REGENTS PARK ROW
Practice Address - Street 2:#345
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-9102
Practice Address - Country:US
Practice Address - Phone:858-677-9700
Practice Address - Fax:858-677-9770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatricsGroup - Multi-Specialty
Not Answered2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHandGroup - Multi-Specialty
Not Answered2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Multi-Specialty
Not Answered2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11570447OtherCAQH
CAZZZ13110ZOtherBLUE SHIELD OF CALIFORNIA
CAWPT28061AMedicare ID - Type UnspecifiedMEDICARE NUMBER