Healthcare Provider Details

I. General information

NPI: 1437969896
Provider Name (Legal Business Name): ASHCARE VIRTUAL PHYSICAL THERAPY ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2025
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10221 WATERIDGE CIR
SAN DIEGO CA
92121-2702
US

IV. Provider business mailing address

10221 WATERIDGE CIR
SAN DIEGO CA
92121-2702
US

V. Phone/Fax

Practice location:
  • Phone: 800-848-3555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. MARC MIRISCH
Title or Position: PRESIDENT & CLINICAL DIRECTOR
Credential: DPT
Phone: 877-226-2663