Provider Demographics
NPI:1740224625
Name:ASSOCIATED PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:ASSOCIATED PHYSICAL THERAPY INC
Other - Org Name:PHYSICAL THERAPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DIRK
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-464-0105
Mailing Address - Street 1:8881 FLETCHER PKWY
Mailing Address - Street 2:SUITE 280
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-6105
Mailing Address - Country:US
Mailing Address - Phone:619-464-0105
Mailing Address - Fax:619-464-4317
Practice Address - Street 1:8881 FLETCHER PKWY
Practice Address - Street 2:SUITE 280
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-6105
Practice Address - Country:US
Practice Address - Phone:619-464-0105
Practice Address - Fax:619-464-4317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33067225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA056749Medicare Oscar/Certification