Provider Demographics
NPI:1952461741
Name:NEXUS PHYSICAL THERAPY
Entity Type:Organization
Organization Name:NEXUS PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:RENO
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MASTERS OF PHYSICAL
Authorized Official - Phone:619-579-1625
Mailing Address - Street 1:P.O. BOX 2696
Mailing Address - Street 2:
Mailing Address - City:ELCAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-2696
Mailing Address - Country:US
Mailing Address - Phone:619-579-1625
Mailing Address - Fax:619-579-1611
Practice Address - Street 1:522 JAMACHA RD
Practice Address - Street 2:
Practice Address - City:ELCAJON
Practice Address - State:CA
Practice Address - Zip Code:92019-2448
Practice Address - Country:US
Practice Address - Phone:619-579-1625
Practice Address - Fax:619-579-1611
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEXUS PHYSICAL THERAPY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-11
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT22612225100000X
CAPT23338225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W18268Medicare UPIN
CAW18572Medicare ID - Type Unspecified