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General NPI Number Information
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NPI Number | 1023269222
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Entity Type | Organization
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Legal Business Name | ASIS PHYSICAL THERAPY, INC.
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Dates
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Enumeration Date | 10/06/2008
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Last Update Date | 02/24/2017
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Provider Practice Location Address
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Address Line | 11848 BERNARDO PLAZA CT STE 100
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City | SAN DIEGO
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State | CA
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Zip | 92128-2417
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Country | US
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Telephone | 888-673-2263
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Fax |
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Provider Business Mailing Address
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Address Line | 11848 BENARDO PLAZA CT SUITE 100
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City | SAN DIEGO
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State | CA
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Zip | 92128
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Country | US
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Telephone | 858-349-4859
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF PHYSICAL THERAPY
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Name | DR. VANESSA MARIE JACKSON
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Credential | DPT
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Telephone | 858-349-4869
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 394995
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License Number State | CA
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