Healthcare Provider Details

I. General information

NPI: 1871931352
Provider Name (Legal Business Name): PHILIP J EFTHEMIS DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2013
Last Update Date: 11/22/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5930 ADOBE RD
TWENTYNINE PALMS CA
92277-2356
US

IV. Provider business mailing address

153 MERRYMONT RD
CHEEKTOWAGA NY
14225-1503
US

V. Phone/Fax

Practice location:
  • Phone: 760-367-1743
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1223985
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40147
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: