Healthcare Provider Details

I. General information

NPI: 1972785384
Provider Name (Legal Business Name): ROBERT JOSEPH FLEMING JR. RPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2007
Last Update Date: 11/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5480 MARENGO AVE
LA MESA CA
91942-2408
US

IV. Provider business mailing address

6994 EL CAMINO REAL SUITE 205-C
CARLSBAD CA
92009-4116
US

V. Phone/Fax

Practice location:
  • Phone: 760-419-2111
  • Fax:
Mailing address:
  • Phone: 760-930-8004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number15810
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: