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General NPI Number Information
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NPI Number | 1659548824
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Entity Type | Individual
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Provider Name | JAMES SPECK MPT
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Gender | Male
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Dates
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Enumeration Date | 05/15/2008
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Last Update Date | 05/15/2008
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Provider Practice Location Address
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Address Line | 5353 MISSION CENTER RD SUITE 221
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City | SAN DIEGO
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State | CA
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Zip | 92108-1306
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Country | US
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Telephone | 619-294-3644
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Fax |
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Provider Business Mailing Address
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Address Line | 10027 RIO SAN DIEGO DR APT 220
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City | SAN DIEGO
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State | CA
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Zip | 92108-5642
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Country | US
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Telephone | 619-294-3644
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | PT 32875
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License Number State | CA
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