Provider Demographics
NPI:1609210038
Name:RDM PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:RDM PHYSICAL THERAPY PC
Other - Org Name:RANCHO DEL MAR PHYSICAL THERAPY PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:LYNETTE
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:858-350-6500
Mailing Address - Street 1:3790 VIA DE LA VALLE
Mailing Address - Street 2:SUITE 205 AND 206
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-4247
Mailing Address - Country:US
Mailing Address - Phone:858-350-6500
Mailing Address - Fax:858-350-6505
Practice Address - Street 1:3790 VIA DE LA VALLE
Practice Address - Street 2:SUITE 205 AND 206
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-4247
Practice Address - Country:US
Practice Address - Phone:858-350-6500
Practice Address - Fax:858-350-6505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-29
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT36347225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty