1770520496 NPI number — EGGLETON & LANGTON PHYSICAL THERAPY MANAGEMENT SERVICES

Table of content: (NPI 1770520496)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770520496 NPI number — EGGLETON & LANGTON PHYSICAL THERAPY MANAGEMENT SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EGGLETON & LANGTON PHYSICAL THERAPY MANAGEMENT SERVICES
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:
PRN POWAY PHYSICAL THERAPY
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:
1770520496
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/07/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5905 SEVERIN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA MESA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91942-3806
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-589-2606
Provider Business Mailing Address Fax Number:
619-464-0900

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15373 INNOVATION DR STE 220
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92128-3425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-592-8855
Provider Business Practice Location Address Fax Number:
858-592-8858
Provider Enumeration Date:
06/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PACE
Authorized Official First Name:
ROB
Authorized Official Middle Name:
Authorized Official Title or Position:
AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
760-268-7500

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)

  • Identifier: ZZZ05343Z . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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