Healthcare Provider Details

I. General information

NPI: 1194727305
Provider Name (Legal Business Name): NORMA KHALIFE ROUILLARD PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 11/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8790 CUYAMACA ST SUITE A
SANTEE CA
92071-4295
US

IV. Provider business mailing address

3760 CONVOY ST STE 101
SAN DIEGO CA
92111-3743
US

V. Phone/Fax

Practice location:
  • Phone: 619-596-5969
  • Fax: 619-596-5970
Mailing address:
  • Phone: 888-208-8526
  • Fax: 858-751-0901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 29262
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: