1265478358 NPI number — CRS PHYSICAL THERAPY INC.

Table of content: (NPI 1265478358)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265478358 NPI number — CRS PHYSICAL THERAPY INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CRS 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:
6
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:
1265478358
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/05/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4501 MISSION BAY DRIVE
Provider Second Line Business Mailing Address:
SUITE 3K
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92109
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-866-0340
Provider Business Mailing Address Fax Number:
858-866-0342

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4501 MISSION BAY DR
Provider Second Line Business Practice Location Address:
SUITE 3K
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92109-4923
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-866-0340
Provider Business Practice Location Address Fax Number:
858-866-0342
Provider Enumeration Date:
06/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FARAJZADEH
Authorized Official First Name:
FARSHID
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER /OPERATOR, PHYSICAL THERAPIST
Authorized Official Telephone Number:
858-866-0340

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT20075 , 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: 810098482 . This is a "PRIVATE HEALTHCARE SYSTEM" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 361238600 . This is a "AFFILIATED COMP SERVICES" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: CA25980605 . This is a "PREFERRED THERAPY PROVDRS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ61556Z . This is a "BLUE SHIELD OF CA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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