Provider Demographics
NPI:1659436525
Name:VONPOHLE, MICHAEL DREW (RPT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:DREW
Last Name:VONPOHLE
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 4TH AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-3813
Mailing Address - Country:US
Mailing Address - Phone:619-422-0145
Mailing Address - Fax:619-422-3121
Practice Address - Street 1:340 4TH AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-3813
Practice Address - Country:US
Practice Address - Phone:619-422-0145
Practice Address - Fax:619-422-3121
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT10015225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT10015Medicare ID - Type UnspecifiedPT LICENSE NUMBER