Healthcare Provider Details

I. General information

NPI: 1295099232
Provider Name (Legal Business Name): JAY ALBRANDT PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2012
Last Update Date: 06/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

8235 HARTON PL
SAN DIEGO CA
92123-3818
US

V. Phone/Fax

Practice location:
  • Phone: 800-458-7777
  • Fax: 800-863-2978
Mailing address:
  • Phone: 858-278-1433
  • Fax: 858-278-1433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberAT3104
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: