Healthcare Provider Details

I. General information

NPI: 1366995870
Provider Name (Legal Business Name): LEVEL 4 PHYSICAL THERAPY AND PERFORMANCE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2016
Last Update Date: 08/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 SAXONY RD STE 105
ENCINITAS CA
92024
US

IV. Provider business mailing address

171 SAXONY RD STE 105
ENCINITAS CA
92024-6776
US

V. Phone/Fax

Practice location:
  • Phone: 760-503-4440
  • Fax: 801-409-2137
Mailing address:
  • Phone: 760-503-4440
  • Fax: 801-409-2137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DAWN DIMITRIS ANDALON
Title or Position: VP
Credential: PT
Phone: 760-503-4440