Healthcare Provider Details

I. General information

NPI: 1619200912
Provider Name (Legal Business Name): TIBBETTS EAST-WEST THERAPY CENTER,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2009
Last Update Date: 07/21/2022
Certification Date: 04/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4956 WARING RD STE A
SAN DIEGO CA
92120-2732
US

IV. Provider business mailing address

4956 WARING RD STE A
SAN DIEGO CA
92120-2732
US

V. Phone/Fax

Practice location:
  • Phone: 619-618-5780
  • Fax:
Mailing address:
  • Phone: 619-618-5780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. JULIE M TIBBETTS
Title or Position: PRESIDENT
Credential: DPT
Phone: 619-618-5780