Healthcare Provider Details

I. General information

NPI: 1568202968
Provider Name (Legal Business Name): ELEONORA VINCE, PHYSICAL THERAPY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2024
Last Update Date: 05/31/2024
Certification Date: 05/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 SAXONY RD STE 207
ENCINITAS CA
92024-6777
US

IV. Provider business mailing address

1811 AUTUMN PL
ENCINITAS CA
92024-1961
US

V. Phone/Fax

Practice location:
  • Phone: 760-206-3076
  • Fax:
Mailing address:
  • Phone: 310-625-2275
  • 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. ELEONORA JOAN VINCE
Title or Position: CEO
Credential: PT, DPT
Phone: 760-206-3076