Provider Demographics
NPI:1932497468
Name:SY, JOSEPH (PT)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:SY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2155 CAMINITO LEONZIO
Mailing Address - Street 2:UNIT 20
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91915-4169
Mailing Address - Country:US
Mailing Address - Phone:858-733-1954
Mailing Address - Fax:800-803-8147
Practice Address - Street 1:2155 CAMINITO LEONZIO
Practice Address - Street 2:UNIT 20
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91915-4169
Practice Address - Country:US
Practice Address - Phone:858-733-1954
Practice Address - Fax:800-803-8147
Is Sole Proprietor?:No
Enumeration Date:2011-07-19
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29883225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist