Provider Demographics
NPI:1790729424
Name:MAHLER, RICHARD KEITH (PT, MPT, CEAS)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:KEITH
Last Name:MAHLER
Suffix:
Gender:M
Credentials:PT, MPT, CEAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7801 MISSION CENTER CT
Mailing Address - Street 2:SUITE 430
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-1313
Mailing Address - Country:US
Mailing Address - Phone:619-296-5780
Mailing Address - Fax:619-296-5787
Practice Address - Street 1:7801 MISSION CENTER CT
Practice Address - Street 2:SUITE 430
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1313
Practice Address - Country:US
Practice Address - Phone:619-296-5780
Practice Address - Fax:619-296-5787
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 269942251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT26994Medicare PIN