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General NPI Number Information
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NPI Number | 1144851361
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Entity Type | Organization
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Legal Business Name | ONE LIFE PHYSICAL THERAPY INC
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Dates
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Enumeration Date | 01/27/2020
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Last Update Date | 01/08/2025
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Provider Practice Location Address
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Address Line | 160 C AVE
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City | CORONADO
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State | CA
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Zip | 92118-1420
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Country | US
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Telephone | 281-851-1613
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Fax |
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Provider Business Mailing Address
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Address Line | 6621 ARCHWOOD AVE
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City | SAN DIEGO
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State | CA
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Zip | 92120-2401
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Country | US
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Telephone | 281-851-1613
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. BRYAN RUSSELL
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Credential | DPT
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Telephone | 281-851-1613
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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