Provider Demographics
NPI:1851392120
Name:SIGAFOOS, GLORIA THERESA (PT OCS CHT)
Entity Type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:THERESA
Last Name:SIGAFOOS
Suffix:
Gender:F
Credentials:PT OCS CHT
Other - Prefix:MRS
Other - First Name:GLORIA
Other - Middle Name:THERESA
Other - Last Name:SIGAFOOS-HENDERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT OCS CHT
Mailing Address - Street 1:5190 GOVERNOR DR
Mailing Address - Street 2:#107
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-2847
Mailing Address - Country:US
Mailing Address - Phone:858-452-0282
Mailing Address - Fax:858-452-6837
Practice Address - Street 1:5190 GOVERNOR DR
Practice Address - Street 2:#107
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-2847
Practice Address - Country:US
Practice Address - Phone:858-452-0282
Practice Address - Fax:858-452-6837
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT9455225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0382172OtherCIGNA HEALTHCARE
CA19-98-9721OtherSTATE FUND
CAZZZ078742OtherBLUE SHIELD
CAZZZ078742OtherBLUE SHIELD