Healthcare Provider Details

I. General information

NPI: 1639747116
Provider Name (Legal Business Name): PROGRESSIVE PHYSICAL THERAPY OF SAN DIEGO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2021
Last Update Date: 06/11/2021
Certification Date: 06/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

681 S MOLLISON AVE STE B
EL CAJON CA
92020-6908
US

IV. Provider business mailing address

681 S MOLLISON AVE STE B
EL CAJON CA
92020-6908
US

V. Phone/Fax

Practice location:
  • Phone: 619-504-0434
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. ALEXANDER PATRICK ALLOS
Title or Position: PRESIDENT
Credential: DPT
Phone: 619-504-0434