Provider Demographics
NPI:1841423613
Name:GASPAR PHYSICAL THERAPY A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:GASPAR PHYSICAL THERAPY A PROFESSIONAL CORPORATION
Other - Org Name:DAGOSTINO PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:SNOW
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:760-692-5142
Mailing Address - Street 1:700 GARDEN VIEW CT
Mailing Address - Street 2:STE 103
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-2478
Mailing Address - Country:US
Mailing Address - Phone:760-692-5142
Mailing Address - Fax:
Practice Address - Street 1:3809 PLAZA DR
Practice Address - Street 2:STE 112
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4625
Practice Address - Country:US
Practice Address - Phone:760-941-2630
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-27
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty