Provider Demographics
NPI:1659703502
Name:PHYSICAL THERAPY EFFECT PC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY EFFECT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:SHULMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:619-544-1055
Mailing Address - Street 1:1601 KETTNER BLVD
Mailing Address - Street 2:SUITE 11
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-2500
Mailing Address - Country:US
Mailing Address - Phone:619-544-1055
Mailing Address - Fax:619-544-1056
Practice Address - Street 1:1601 KETTNER BLVD
Practice Address - Street 2:SUITE 11
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-2500
Practice Address - Country:US
Practice Address - Phone:619-544-1055
Practice Address - Fax:619-544-1056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-02
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36879225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADZ982ZMedicare PIN