1073999264 NPI number — HOME PHYSICAL THERAPY PROVIDERS & WELLNESS INC.

Table of content: MR. BRADY EVAN CLEVENGER MS PLPC (NPI 1720049471)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073999264 NPI number — HOME PHYSICAL THERAPY PROVIDERS & WELLNESS INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOME PHYSICAL THERAPY PROVIDERS & WELLNESS 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:
Provider Other Organization Name Type Code:
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:
1073999264
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1611A S MELROSE DR # 311
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VISTA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92081-5471
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-536-2377
Provider Business Mailing Address Fax Number:
888-415-0603

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
403 W 5TH AVE
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
ESCONDIDO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92025-4872
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-536-2377
Provider Business Practice Location Address Fax Number:
888-415-0603
Provider Enumeration Date:
08/11/2015

Additional Information

Authorized Official

Authorized Official Last Name:
SHEEHY
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
NORMAN
Authorized Official Title or Position:
PRESIDENT/PHYSICAL THERAPIST
Authorized Official Telephone Number:
760-201-5359

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  36095 , 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 © 2007-2025 www.npivalidator.com