Provider Demographics
NPI:1851664072
Name:GASPAR PHYSICAL THERAPY A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:GASPAR PHYSICAL THERAPY A PROFESSIONAL CORPORATION
Other - Org Name:DOCTORS OF 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:
Authorized Official - Last Name:SNOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-692-5142
Mailing Address - Street 1:6102 AVENIDA ENCINAS
Mailing Address - Street 2:STE E
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-1005
Mailing Address - Country:US
Mailing Address - Phone:760-634-9750
Mailing Address - Fax:760-634-9752
Practice Address - Street 1:6102 AVENIDA ENCINAS
Practice Address - Street 2:STE E
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92011-1005
Practice Address - Country:US
Practice Address - Phone:760-634-9750
Practice Address - Fax:760-634-9752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-18
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14624Medicare UPIN