Healthcare Provider Details

I. General information

NPI: 1104446301
Provider Name (Legal Business Name): ART OF PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2020
Last Update Date: 04/17/2020
Certification Date: 04/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2606 LIGHTNING TRAIL LN
CHULA VISTA CA
91915-1598
US

IV. Provider business mailing address

2606 LIGHTNING TRAIL LN
CHULA VISTA CA
91915-1598
US

V. Phone/Fax

Practice location:
  • Phone: 949-355-4790
  • Fax:
Mailing address:
  • Phone: 949-355-4790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. TREVOR D'SOUZA
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: DPT
Phone: 949-355-4790