Provider Demographics
NPI:1548391758
Name:ENCINITAS PHYSICAL THERAPY
Entity Type:Organization
Organization Name:ENCINITAS PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:STURMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:760-753-0703
Mailing Address - Street 1:345 SANTA FE DR
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-5132
Mailing Address - Country:US
Mailing Address - Phone:760-753-0703
Mailing Address - Fax:760-753-0272
Practice Address - Street 1:345 SANTA FE DR
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-5132
Practice Address - Country:US
Practice Address - Phone:760-753-0703
Practice Address - Fax:760-753-0272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 8046225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2251X0800XMedicare ID - Type UnspecifiedMEDICARE
CAW14477Medicare PIN