Healthcare Provider Details

I. General information

NPI: 1457023756
Provider Name (Legal Business Name): HARDY AND LUKES PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2021
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2445 TRUXTUN RD STE 201
SAN DIEGO CA
92106-6154
US

IV. Provider business mailing address

41769 ENTERPRISE CIR N STE 104-105
TEMECULA CA
92590-5626
US

V. Phone/Fax

Practice location:
  • Phone: 619-501-9755
  • Fax:
Mailing address:
  • Phone: 951-303-8255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TERRA RAE SCOTT
Title or Position: SVP OUTPATIENT PEDIATRICS
Credential: MSPT
Phone: 303-437-4364