Healthcare Provider Details

I. General information

NPI: 1992658553
Provider Name (Legal Business Name): SIVA PERFORMANCE AND WELLNESS PHYSICAL THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2026
Last Update Date: 02/16/2026
Certification Date: 02/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 VANITA ST
FALLBROOK CA
92028-1554
US

IV. Provider business mailing address

935 VANITA ST
FALLBROOK CA
92028-1554
US

V. Phone/Fax

Practice location:
  • Phone: 760-803-7686
  • 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: ANDREW SIVA
Title or Position: OWNER, PRESIDENT
Credential: PT, DPT
Phone: 760-803-7686