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General NPI Number Information
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NPI Number | 1174867154
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Entity Type | Organization
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Legal Business Name | VITAL PHYSICAL THERAPY INC.
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Dates
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Enumeration Date | 11/15/2012
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Last Update Date | 08/22/2018
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Provider Practice Location Address
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Address Line | 5820 OBERLIN DR STE 111
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City | SAN DIEGO
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State | CA
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Zip | 92121-3743
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Country | US
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Telephone | 858-255-7976
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Fax | 858-255-7969
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Provider Business Mailing Address
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Address Line | PO BOX 910883
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City | SAN DIEGO
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State | CA
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Zip | 92191-0883
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Country | US
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Telephone | 858-255-7976
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Fax | 858-255-7969
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Authorized Official
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Title or Position | PRESIDENT
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Name | KOMAL DEOKULE
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Credential |
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Telephone | 858-255-7976
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251C2600X
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Taxonomy Name | Cardiopulmonary Physical Therapist
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License Number | 35986
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License Number State | CA
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