Healthcare Provider Details

I. General information

NPI: 1760831143
Provider Name (Legal Business Name): THERASTAFF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2016
Last Update Date: 06/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2355 NORTHSIDE DR SUITE 100
SAN DIEGO CA
92108-2705
US

IV. Provider business mailing address

2355 NORTHSIDE DR SUITE 100
SAN DIEGO CA
92108-2705
US

V. Phone/Fax

Practice location:
  • Phone: 800-458-7777
  • Fax: 800-863-2978
Mailing address:
  • Phone: 800-458-7777
  • Fax: 800-863-2978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIAM STONE
Title or Position: PRESIDENT
Credential:
Phone: 619-260-3914