Provider Demographics
NPI:1841765138
Name:SD ELITE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:SD ELITE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:925-219-2621
Mailing Address - Street 1:510 HACIENDA DR STE 107
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081-6639
Mailing Address - Country:US
Mailing Address - Phone:760-630-8060
Mailing Address - Fax:
Practice Address - Street 1:510 HACIENDA DR STE 107
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-6639
Practice Address - Country:US
Practice Address - Phone:760-630-8060
Practice Address - Fax:760-630-7715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-12
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty