Healthcare Provider Details

I. General information

NPI: 1124931696
Provider Name (Legal Business Name): NICHOLAS JONGETJES PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5850 EL CAMINO REAL STE 111
CARLSBAD CA
92008-8816
US

IV. Provider business mailing address

3959 RUFFIN RD STE J
SAN DIEGO CA
92123-1830
US

V. Phone/Fax

Practice location:
  • Phone: 760-542-2414
  • Fax: 760-542-2415
Mailing address:
  • Phone: 858-279-5570
  • Fax: 858-279-5303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT311033
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: