Provider Demographics
NPI:1740242510
Name:DEL MAR PHYSICAL THERAPY, INC
Entity Type:Organization
Organization Name:DEL MAR PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINTAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-755-1229
Mailing Address - Street 1:317 14TH ST
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-2554
Mailing Address - Country:US
Mailing Address - Phone:858-755-1229
Mailing Address - Fax:858-755-0720
Practice Address - Street 1:317 14TH ST
Practice Address - Street 2:
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-2554
Practice Address - Country:US
Practice Address - Phone:858-755-1229
Practice Address - Fax:858-755-0720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW15896Medicare ID - Type UnspecifiedPROVIDER #