Healthcare Provider Details

I. General information

NPI: 1235187550
Provider Name (Legal Business Name): BARBARA JEAN BOUTELLE/CARLSBAD PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 10/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6195 CORNERSTONE CT STE. 101
SAN DIEGO CA
92121-4728
US

IV. Provider business mailing address

600 S ANDREASEN DR STE C
ESCONDIDO CA
92029-1917
US

V. Phone/Fax

Practice location:
  • Phone: 858-452-4324
  • Fax: 858-452-3102
Mailing address:
  • Phone: 760-591-7750
  • Fax: 760-294-9813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateCA

VIII. Authorized Official

Name: MS. BARBARA JEAN BOUTELLE
Title or Position: OWNER/SECRETARY
Credential: R.P.T
Phone: 760-591-7750