Provider Demographics
NPI:1619268919
Name:GINGRAS, BRIAN A (DPT)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:A
Last Name:GINGRAS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3959 RUFFIN RD
Mailing Address - Street 2:STE J
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1830
Mailing Address - Country:US
Mailing Address - Phone:858-279-5570
Mailing Address - Fax:585-279-5303
Practice Address - Street 1:3323 CARMEL MOUNTAIN RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1035
Practice Address - Country:US
Practice Address - Phone:858-720-0991
Practice Address - Fax:858-720-0992
Is Sole Proprietor?:No
Enumeration Date:2011-04-21
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 37662225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist