Provider Demographics
NPI:1902603475
Name:CORREA, EVA (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:EVA
Middle Name:
Last Name:CORREA
Suffix:
Gender:
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7565 BANNISTER LN
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-5621
Mailing Address - Country:US
Mailing Address - Phone:858-610-2997
Mailing Address - Fax:
Practice Address - Street 1:5433 NEW MILLS RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-2247
Practice Address - Country:US
Practice Address - Phone:760-960-1654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA193852251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics