Healthcare Provider Details

I. General information

NPI: 1588800874
Provider Name (Legal Business Name): IN-HOME PHYSICAL THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2008
Last Update Date: 07/15/2020
Certification Date: 07/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

533 2ND ST # 341
ENCINITAS CA
92024-3558
US

IV. Provider business mailing address

533 2ND ST # 341
ENCINITAS CA
92024-3558
US

V. Phone/Fax

Practice location:
  • Phone: 760-271-3850
  • Fax: 888-773-3272
Mailing address:
  • Phone: 760-271-3850
  • Fax: 888-773-3272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. JAMES A PRUSSACK JR.
Title or Position: PRESIDENT, OWNER
Credential: PT
Phone: 760-271-3850