Provider Demographics
NPI:1508816943
Name:BEDROSSIAN, JAMES E (PT)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:E
Last Name:BEDROSSIAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 N. EL CAMINO REAL
Mailing Address - Street 2:#210
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-2813
Mailing Address - Country:US
Mailing Address - Phone:760-337-1144
Mailing Address - Fax:760-337-8259
Practice Address - Street 1:1611 W MAIN ST
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-2212
Practice Address - Country:US
Practice Address - Phone:760-337-1144
Practice Address - Fax:760-337-8259
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 28666225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT28666AMedicare PIN