Provider Demographics
NPI:1851576839
Name:CBAD ENTERPRISES, INC
Entity Type:Organization
Organization Name:CBAD ENTERPRISES, INC
Other - Org Name:SUSAN CROKE PHYSICAL THERAPY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:CROKE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:760-603-7900
Mailing Address - Street 1:2588 EL CAMINO REAL
Mailing Address - Street 2:F249
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-1211
Mailing Address - Country:US
Mailing Address - Phone:760-603-7900
Mailing Address - Fax:760-603-7997
Practice Address - Street 1:6215 EL CAMINO REAL STE 100
Practice Address - Street 2:ELITE PERFORMANCE INSTITUTE
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-1604
Practice Address - Country:US
Practice Address - Phone:760-603-7900
Practice Address - Fax:760-603-7997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT19837261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1265480560OtherNPI
CAPT 19837OtherPT LICENSE