1164668141 NPI number — OUTCOMES PHYSICAL THERAPY, INC.

Table of content: (NPI 1164668141)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164668141 NPI number — OUTCOMES PHYSICAL THERAPY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OUTCOMES 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:
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:
1164668141
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5255 WILLOW WALK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OCEANSIDE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92057-1925
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-687-3541
Provider Business Mailing Address Fax Number:
760-529-9292

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
760 WASHBURN AVE
Provider Second Line Business Practice Location Address:
STE 2
Provider Business Practice Location Address City Name:
CORONA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92882-3303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-371-1233
Provider Business Practice Location Address Fax Number:
951-371-1273
Provider Enumeration Date:
12/23/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BASA
Authorized Official First Name:
ALEXANDER
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
760-687-3541

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  PT28665 , 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)

  • Identifier: 1972671360 . This is a "NPI PERSONAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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