Provider Demographics
NPI:1922490895
Name:TRAILS PHYSICAL THERAPY
Entity Type:Organization
Organization Name:TRAILS PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:SHAUN
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:858-692-5835
Mailing Address - Street 1:6717 MURRAY PARK DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-3911
Mailing Address - Country:US
Mailing Address - Phone:858-692-5835
Mailing Address - Fax:619-825-7500
Practice Address - Street 1:7676 JACKSON DR STE 4
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92119-1515
Practice Address - Country:US
Practice Address - Phone:858-692-5835
Practice Address - Fax:619-825-7500
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRIT IN HOME PHYSICAL THERAPY LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-02
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT20328225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty