Provider Demographics
NPI:1134166838
Name:EGGLETON & LANGTON PHYSICAL THERAPY MANAGEMENT SERVICES
Entity type:Organization
Organization Name:EGGLETON & LANGTON PHYSICAL THERAPY MANAGEMENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MCKEOWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-295-3000
Mailing Address - Street 1:317 N EL CAMINO REAL
Mailing Address - Street 2:#210
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-2811
Mailing Address - Country:US
Mailing Address - Phone:760-634-0248
Mailing Address - Fax:760-634-1782
Practice Address - Street 1:4060 4TH AVE
Practice Address - Street 2:#206
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2116
Practice Address - Country:US
Practice Address - Phone:619-299-5246
Practice Address - Fax:619-299-5751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 6689225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ05345ZOtherBLUE SHIELD
CAZZZ05345ZOtherBLUE SHIELD