1669845798 NPI number — G3 PHYSICAL THERAPY AND WELLNESS CENTER PC

Table of content: (NPI 1669845798)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669845798 NPI number — G3 PHYSICAL THERAPY AND WELLNESS CENTER PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
G3 PHYSICAL THERAPY AND WELLNESS CENTER PC
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:
1669845798
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/22/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
227 N EL CAMINO REAL STE 100
Provider Second Line Business Mailing Address:
SUITE#100
Provider Business Mailing Address City Name:
ENCINITAS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92024-5821
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-205-1500
Provider Business Mailing Address Fax Number:
760-994-4641

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
740 LOMAS SANTA FE DR STE 208
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:
92075-1441
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-452-2640
Provider Business Practice Location Address Fax Number:
760-452-2643
Provider Enumeration Date:
11/11/2015

Additional Information

Authorized Official

Authorized Official Last Name:
VAN GILDER
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
760-205-1500

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; 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