Provider Demographics
NPI:1912310459
Name:INTORRE, ANITA ANNE (DPT)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:ANNE
Last Name:INTORRE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 SAN FERNANDO PL
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-8045
Mailing Address - Country:US
Mailing Address - Phone:610-220-0068
Mailing Address - Fax:
Practice Address - Street 1:817 SAN FERNANDO PL
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-8045
Practice Address - Country:US
Practice Address - Phone:610-220-0068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-03
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPA019582225100000X
CA42669225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist