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General NPI Number Information
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NPI Number | 1760617781
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Entity Type | Individual
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Provider Name | MICHELLE EISENBERG PT
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Gender | Female
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Dates
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Enumeration Date | 05/19/2009
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Last Update Date | 05/19/2009
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Provider Practice Location Address
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Address Line | 4165 VIA CANDIDIZ UNIT 30
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City | SAN DIEGO
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State | CA
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Zip | 92130-2189
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Country | US
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Telephone | 858-481-2535
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Fax | 858-481-2532
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Provider Business Mailing Address
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Address Line | PO BOX 12501
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City | LA JOLLA
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State | CA
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Zip | 92039-2501
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Country | US
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Telephone | 858-481-2535
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Fax | 858-481-2532
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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 | 2251E1200X
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Taxonomy Name | Ergonomics Physical Therapist
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License Number | PT 14819
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License Number State | CA
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