Provider Demographics
NPI:1588800874
Name:IN-HOME PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:IN-HOME PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:PRUSSACK
Authorized Official - Suffix:JR
Authorized Official - Credentials:PT
Authorized Official - Phone:760-271-3850
Mailing Address - Street 1:533 2ND ST # 341
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-3558
Mailing Address - Country:US
Mailing Address - Phone:760-271-3850
Mailing Address - Fax:888-773-3272
Practice Address - Street 1:533 2ND ST # 341
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-3558
Practice Address - Country:US
Practice Address - Phone:760-271-3850
Practice Address - Fax:888-773-3272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-17
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QM1300X
261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABR067AMedicare UPIN