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General NPI Number Information
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NPI Number | 1528458874
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Entity Type | Organization
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Legal Business Name | FLOOR PT INC
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Dates
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Enumeration Date | 01/26/2015
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Last Update Date | 05/22/2015
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Provider Practice Location Address
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Address Line | 910 W SAN MARCOS BLVD STE 109
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City | SAN MARCOS
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State | CA
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Zip | 92078-1115
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Country | US
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Telephone | 760-502-6111
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Fax | 760-683-3286
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Provider Business Mailing Address
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Address Line | 4764 CRATER RIM RD
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City | CARLSBAD
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State | CA
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Zip | 92010-5548
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Country | US
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Telephone | 760-502-6111
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Fax | 760-683-3286
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Authorized Official
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Title or Position | OWNER
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Name | MRS. ANUJA B SHAH
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Credential | DOCTORATE
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Telephone | 760-502-6111
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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 | PT36437
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License Number State | CA
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