Provider Demographics
NPI:1497147060
Name:JG PERFORMANCE FITNESS, INC.
Entity Type:Organization
Organization Name:JG PERFORMANCE FITNESS, INC.
Other - Org Name:HEALTHWEST THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:GWENDOLYN
Authorized Official - Middle Name:R
Authorized Official - Last Name:ALDEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:619-373-6100
Mailing Address - Street 1:390 AVENIDA LA CUESTA
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-4207
Mailing Address - Country:US
Mailing Address - Phone:619-373-6100
Mailing Address - Fax:559-639-5250
Practice Address - Street 1:1482 LA MIRADA DR
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-2414
Practice Address - Country:US
Practice Address - Phone:619-373-6100
Practice Address - Fax:559-639-5250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-19
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35685261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy