Healthcare Provider Details

I. General information

NPI: 1790839710
Provider Name (Legal Business Name): LA MESA PHYSICAL THERAPY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8939 LA MESA BLVD SUITE 1
LA MESA CA
91942-9057
US

IV. Provider business mailing address

8939 LA MESA BLVD SUITE 1
LA MESA CA
91942-9057
US

V. Phone/Fax

Practice location:
  • Phone: 619-464-1352
  • Fax: 619-464-7255
Mailing address:
  • Phone: 619-464-1352
  • Fax: 619-464-7255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. GERALD D NASH
Title or Position: PRESIDENT
Credential: MED, RPT
Phone: 619-464-1352