Healthcare Provider Details

I. General information

NPI: 1447535893
Provider Name (Legal Business Name): RECHY SESE PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2011
Last Update Date: 07/13/2023
Certification Date: 07/13/2023
Deactivation Date: 05/08/2018
Reactivation Date: 07/13/2023

III. Provider practice location address

10595 MATSON WAY
SAN DIEGO CA
92126-3059
US

IV. Provider business mailing address

10595 MATSON WAY
SAN DIEGO CA
92126-3059
US

V. Phone/Fax

Practice location:
  • Phone: 858-382-8708
  • Fax:
Mailing address:
  • Phone: 858-382-8708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number29706
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: