Provider Demographics
NPI:1619200912
Name:TIBBETTS EAST-WEST THERAPY CENTER,INC
Entity Type:Organization
Organization Name:TIBBETTS EAST-WEST THERAPY CENTER,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:TIBBETTS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:619-618-5780
Mailing Address - Street 1:4956 WARING RD
Mailing Address - Street 2:STE A
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-2732
Mailing Address - Country:US
Mailing Address - Phone:619-618-5780
Mailing Address - Fax:
Practice Address - Street 1:4956 WARING RD
Practice Address - Street 2:STE A
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-2732
Practice Address - Country:US
Practice Address - Phone:619-618-5780
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========Other=========