Provider Demographics
NPI:1669845798
Name:G3 PHYSICAL THERAPY AND WELLNESS CENTER PC
Entity Type:Organization
Organization Name:G3 PHYSICAL THERAPY AND WELLNESS CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN GILDER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:760-205-1500
Mailing Address - Street 1:227 N EL CAMINO REAL STE 100
Mailing Address - Street 2:SUITE#100
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-5821
Mailing Address - Country:US
Mailing Address - Phone:760-205-1500
Mailing Address - Fax:760-994-4641
Practice Address - Street 1:740 LOMAS SANTA FE DR STE 208
Practice Address - Street 2:
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-1441
Practice Address - Country:US
Practice Address - Phone:760-452-2640
Practice Address - Fax:760-452-2643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-11
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty