Provider Demographics
NPI:1598817900
Name:CREAMER PHYSICAL THERAPY INC.
Entity Type:Organization
Organization Name:CREAMER PHYSICAL THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:P.T. - OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:MAY
Authorized Official - Last Name:PRITCHETT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:858-551-8882
Mailing Address - Street 1:7946 IVANHOE AVE
Mailing Address - Street 2:110
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-4516
Mailing Address - Country:US
Mailing Address - Phone:858-551-8882
Mailing Address - Fax:858-551-0593
Practice Address - Street 1:7946 IVANHOE AVE
Practice Address - Street 2:110
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-4516
Practice Address - Country:US
Practice Address - Phone:858-551-8882
Practice Address - Fax:858-551-0593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT14588225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT14588Medicare UPIN