Provider Demographics
NPI:1801172713
Name:D&M GROSS, INC.
Entity type:Organization
Organization Name:D&M GROSS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:760-560-7899
Mailing Address - Street 1:4849 GLENHOLLOW CIR
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92057-7941
Mailing Address - Country:US
Mailing Address - Phone:760-560-7899
Mailing Address - Fax:760-603-7997
Practice Address - Street 1:6215 EL CAMINO REAL
Practice Address - Street 2:SUITE 100
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-1610
Practice Address - Country:US
Practice Address - Phone:760-560-7899
Practice Address - Fax:760-603-7997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-25
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17061225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty