Provider Demographics
NPI:1336154301
Name:M DREW VON POHLE PHYSICAL THERAPY A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:M DREW VON POHLE PHYSICAL THERAPY A PROFESSIONAL CORPORATION
Other - Org Name:SOUTH BAY PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:M
Authorized Official - Middle Name:DREW
Authorized Official - Last Name:VON POHLE
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:619-422-0145
Mailing Address - Street 1:637 3RD AVE
Mailing Address - Street 2:SUITE H
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-5707
Mailing Address - Country:US
Mailing Address - Phone:619-422-0145
Mailing Address - Fax:619-422-3121
Practice Address - Street 1:637 3RD AVE
Practice Address - Street 2:SUITE H
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-5707
Practice Address - Country:US
Practice Address - Phone:619-422-0145
Practice Address - Fax:619-422-3121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT10015225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========Medicare UPIN
CAPT10015Medicare ID - Type Unspecified