Provider Demographics
NPI:1295099232
Name:ALBRANDT, JAY (PTA)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:ALBRANDT
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8235 HARTON PL
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-3818
Mailing Address - Country:US
Mailing Address - Phone:858-278-1433
Mailing Address - Fax:858-278-1433
Practice Address - Street 1:2355 NORTHSIDE DR
Practice Address - Street 2:#100
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-2705
Practice Address - Country:US
Practice Address - Phone:800-458-7777
Practice Address - Fax:800-863-2978
Is Sole Proprietor?:No
Enumeration Date:2012-06-25
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT3104225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant