Provider Demographics
NPI:1902012875
Name:GASPAR PHYSICAL THERAPY A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:GASPAR PHYSICAL THERAPY A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COE
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 1:981 LOMAS SANTA FE DR STE A
Mailing Address - Street 2:
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-2144
Mailing Address - Country:US
Mailing Address - Phone:858-794-9995
Mailing Address - Fax:858-794-9962
Practice Address - Street 1:981 LOMAS SANTA FE DR STE A
Practice Address - Street 2:
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-2144
Practice Address - Country:US
Practice Address - Phone:858-794-9995
Practice Address - Fax:858-794-9962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14625AMedicare ID - Type Unspecified