Healthcare Provider Details

I. General information

NPI: 1588282594
Provider Name (Legal Business Name): CHR PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2020
Last Update Date: 07/16/2020
Certification Date: 07/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2694 ESCALA CIR
SAN DIEGO CA
92108-6720
US

IV. Provider business mailing address

2127 OLYMPIC PKWY # 1006-602
CHULA VISTA CA
91915-1359
US

V. Phone/Fax

Practice location:
  • Phone: 619-306-1744
  • Fax:
Mailing address:
  • Phone: 619-306-1744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code2251C2600X
TaxonomyCardiopulmonary Physical Therapist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number
License Number StateNULL
# 5
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MARIA FERNANDA PENUNURI
Title or Position: OWNER
Credential: DPT
Phone: 619-306-1744