Healthcare Provider Details

I. General information

NPI: 1831582592
Provider Name (Legal Business Name): BEWELL HOME PHYSICAL THERAPY P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2015
Last Update Date: 05/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1582 W SAN MARCOS BLVD STE 105B
SAN MARCOS CA
92078
US

IV. Provider business mailing address

3011 44TH ST
SAN DIEGO CA
92105-4316
US

V. Phone/Fax

Practice location:
  • Phone: 650-452-4110
  • 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 State

VIII. Authorized Official

Name: KYOKO YAMADA
Title or Position: DIRECTOR
Credential:
Phone: 650-452-4110