Provider Demographics
NPI:1750434494
Name:BIASOTTI, DAVID P (PT)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:P
Last Name:BIASOTTI
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 1:140 WALNUT AVE
Mailing Address - Street 2:UNIT 3E
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-4844
Mailing Address - Country:US
Mailing Address - Phone:619-379-6465
Mailing Address - Fax:
Practice Address - Street 1:140 WALNUT AVE
Practice Address - Street 2:UNIT 3E
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-4844
Practice Address - Country:US
Practice Address - Phone:619-379-6465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT27475225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA056674Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER