1295783520 NPI number — BARBARA JEAN BOUTELLE/CARLSBAD PHYSICAL THERAPY

Table of content: (NPI 1295783520)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295783520 NPI number — BARBARA JEAN BOUTELLE/CARLSBAD PHYSICAL THERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BARBARA JEAN BOUTELLE/CARLSBAD PHYSICAL THERAPY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
EASTLAKE PHYSICAL THERAPY AND HANDCENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295783520
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 S ANDREASEN DR
Provider Second Line Business Mailing Address:
STE C
Provider Business Mailing Address City Name:
ESCONDIDO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92029-1917
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-591-7750
Provider Business Mailing Address Fax Number:
760-294-9813

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
891 KUHN DR
Provider Second Line Business Practice Location Address:
STE. 101
Provider Business Practice Location Address City Name:
CHULA VISTA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91914-3551
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-656-6470
Provider Business Practice Location Address Fax Number:
619-656-6614
Provider Enumeration Date:
05/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BOUTELLE
Authorized Official First Name:
BARBARA
Authorized Official Middle Name:
JEAN
Authorized Official Title or Position:
OWNER/SECRETARY
Authorized Official Telephone Number:
760-591-7750

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2251H1200X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XH1200X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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