=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386851467
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GASPAR PHYSICAL THERAPY, APC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/17/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1011 DEVONSHIRE DR STE F
-----------------------------------------------------
City | ENCINITAS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92024-5136
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-635-0045
-----------------------------------------------------
Fax | 760-634-9752
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1011 DEVONSHIRE DR STE F
-----------------------------------------------------
City | ENCINITAS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92024-5136
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-635-0045
-----------------------------------------------------
Fax | 760-634-9752
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | PAUL DAVID GASPAR
-----------------------------------------------------
Credential | DPT
-----------------------------------------------------
Telephone | 760-634-9750
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------