Healthcare Provider Details

I. General information

NPI: 1790504868
Provider Name (Legal Business Name): ADDISON DEE PASCARELLA DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2024
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3633 VISTA WAY
OCEANSIDE CA
92056-4568
US

IV. Provider business mailing address

240 SOPHIA WAY
OCEANSIDE CA
92057-7367
US

V. Phone/Fax

Practice location:
  • Phone: 760-729-7298
  • Fax: 760-729-7206
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number308117
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT40963
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: