Healthcare Provider Details

I. General information

NPI: 1437724820
Provider Name (Legal Business Name): COMBAT PHYSICAL AND OCCUPATIONAL THERAPY , INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2021
Last Update Date: 05/26/2021
Certification Date: 05/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3919 NORMAL ST APT 206
SAN DIEGO CA
92103-3463
US

IV. Provider business mailing address

1041 MARKET ST # 190
SAN DIEGO CA
92101-7233
US

V. Phone/Fax

Practice location:
  • Phone: 412-952-9726
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: GINA CORNACCHIONE
Title or Position: PHYSICAL AND OCCUPATIONAL THERAPIST
Credential: OTR/L, DPT
Phone: 412-952-9726