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General NPI Number Information
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NPI Number | 1295464675
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Entity Type | Organization
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Legal Business Name | BASE CAMP PHYSICAL THERAPY
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Dates
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Enumeration Date | 06/09/2022
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Last Update Date | 10/03/2023
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Provider Practice Location Address
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Address Line | 29105 VALLEY CENTER RD STE 150
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City | VALLEY CENTER
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State | CA
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Zip | 92082-6536
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Country | US
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Telephone | 626-375-8445
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Fax |
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Provider Business Mailing Address
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Address Line | 13521 CORRAL CT
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City | VALLEY CENTER
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State | CA
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Zip | 92082-6971
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Country | US
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Telephone | 626-375-8445
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | KIMBERLY TAKAOKA-MARTINEAU
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Credential | DPT
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Telephone | 626-375-8445
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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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