Healthcare Provider Details

I. General information

NPI: 1215633672
Provider Name (Legal Business Name): THE ERGONOMIC PHYSICAL THERAPIST, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2023
Last Update Date: 02/06/2023
Certification Date: 02/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

281 GARDENDALE RD
ENCINITAS CA
92024-3017
US

IV. Provider business mailing address

281 GARDENDALE RD
ENCINITAS CA
92024-3017
US

V. Phone/Fax

Practice location:
  • Phone: 619-977-2414
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CARISSA BEYER
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 619-977-2414