Healthcare Provider Details

I. General information

NPI: 1851576839
Provider Name (Legal Business Name): CBAD ENTERPRISES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2008
Last Update Date: 01/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6215 EL CAMINO REAL STE 100 ELITE PERFORMANCE INSTITUTE
CARLSBAD CA
92009-1604
US

IV. Provider business mailing address

2588 EL CAMINO REAL F249
CARLSBAD CA
92008-1211
US

V. Phone/Fax

Practice location:
  • Phone: 760-603-7900
  • Fax: 760-603-7997
Mailing address:
  • Phone: 760-603-7900
  • Fax: 760-603-7997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT19837
License Number StateCA

VIII. Authorized Official

Name: SUSAN LYNNE CROKE
Title or Position: PHYSICAL THERAPIST
Credential: P.T.
Phone: 760-603-7900