Healthcare Provider Details

I. General information

NPI: 1306394382
Provider Name (Legal Business Name): NORTH COUNTY SPORTS MEDICINE AND PHYSICAL THERAPY CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2016
Last Update Date: 10/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4055 OCEANSIDE BLVD STE C
OCEANSIDE CA
92056-5821
US

IV. Provider business mailing address

4055 OCEANSIDE BLVD STE C
OCEANSIDE CA
92056-5821
US

V. Phone/Fax

Practice location:
  • Phone: 760-586-2728
  • Fax:
Mailing address:
  • Phone: 760-586-2728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number39553
License Number StateCA

VIII. Authorized Official

Name: DR. JENNIFER SHARPE
Title or Position: PT/OWNER
Credential: PT
Phone: 760-586-2728