Provider Demographics
NPI:1770584062
Name:UNIVERSITY CITY PHYSICAL THERAPY
Entity type:Organization
Organization Name:UNIVERSITY CITY PHYSICAL THERAPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER / PHYSICAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:THERESA
Authorized Official - Last Name:SIGAFOOS
Authorized Official - Suffix:
Authorized Official - Credentials:PT, OCS, CHT
Authorized Official - Phone:858-452-0282
Mailing Address - Street 1:5190 GOVERNOR DR
Mailing Address - Street 2:#107
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-2847
Mailing Address - Country:US
Mailing Address - Phone:858-452-0282
Mailing Address - Fax:858-452-6837
Practice Address - Street 1:5190 GOVERNOR DR
Practice Address - Street 2:#107
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-2847
Practice Address - Country:US
Practice Address - Phone:858-452-0282
Practice Address - Fax:858-452-6837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0382172OtherCIGNA HEALTHCARE
CA19-98-9721OtherSTATE FUND
CA0382172OtherCIGNA HEALTHCARE