1528515806 NPI number — GERBARG PHYSICAL THERAPY, INC.

Table of content: (NPI 1528515806)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528515806 NPI number — GERBARG PHYSICAL THERAPY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GERBARG PHYSICAL THERAPY, INC.
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:
ONE NINE SPORTS MEDICINE AND PHYSICAL THERAPY, INC.
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:
1528515806
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/05/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2586 LUCIERNAGA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARLSBAD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92009-5819
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-848-6639
Provider Business Mailing Address Fax Number:
844-231-8868

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
722 GENEVIEVE ST STE S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOLANA BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92075-2061
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-848-6639
Provider Business Practice Location Address Fax Number:
844-231-8868
Provider Enumeration Date:
09/05/2016

Additional Information

Authorized Official

Authorized Official Last Name:
GERBARG
Authorized Official First Name:
DAVE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
858-848-6639

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  39289 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com