1366995870 NPI number — LEVEL 4 PHYSICAL THERAPY AND PERFORMANCE, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366995870 NPI number — LEVEL 4 PHYSICAL THERAPY AND PERFORMANCE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEVEL 4 PHYSICAL THERAPY AND PERFORMANCE, 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:
LEVEL4 PHYSIO-WELLNESS-PERFORMANCE
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:
1366995870
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/21/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
171 SAXONY RD STE 105
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ENCINITAS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92024-6776
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-503-4440
Provider Business Mailing Address Fax Number:
801-409-2137

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
171 SAXONY RD STE 105
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ENCINITAS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-503-4440
Provider Business Practice Location Address Fax Number:
801-409-2137
Provider Enumeration Date:
08/02/2016

Additional Information

Authorized Official

Authorized Official Last Name:
ANDALON
Authorized Official First Name:
DAWN
Authorized Official Middle Name:
DIMITRIS
Authorized Official Title or Position:
VP
Authorized Official Telephone Number:
760-503-4440

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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