Healthcare Provider Details

I. General information

NPI: 1790996304
Provider Name (Legal Business Name): THERAPEUTIC HEALTH INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 06/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1337 BLUE SAGE WAY
CHULA VISTA CA
91915-1616
US

IV. Provider business mailing address

1337 BLUE SAGE WAY
CHULA VISTA CA
91915-1616
US

V. Phone/Fax

Practice location:
  • Phone: 619-398-6990
  • Fax: 619-754-6907
Mailing address:
  • Phone: 619-398-6990
  • Fax: 619-754-6907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License NumberB20030226685
License Number StateCA

VIII. Authorized Official

Name: MARISSA AGATHA SHEPPARD
Title or Position: PRESIDENT
Credential: OTRL
Phone: 619-398-6990