Healthcare Provider Details

I. General information

NPI: 1831165323
Provider Name (Legal Business Name): DAGOSTINO PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3809 PLAZA DR STE 112
OCEANSIDE CA
92056-4625
US

IV. Provider business mailing address

3809 PLAZA DR STE 112
OCEANSIDE CA
92056-4625
US

V. Phone/Fax

Practice location:
  • Phone: 760-941-2630
  • Fax: 760-941-4617
Mailing address:
  • Phone: 760-941-2630
  • Fax: 760-941-4617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES JOSEPH DAGOSTINO
Title or Position: PRESIDENT
Credential: DPT PT
Phone: 760-941-2630