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General NPI Number Information
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NPI Number | 1841610847
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Entity Type | Organization
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Legal Business Name | ALPHA PHYSICAL THERAPY AND PERFORMANCE, INC
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Dates
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Enumeration Date | 04/17/2014
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Last Update Date | 04/17/2014
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Provider Practice Location Address
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Address Line | 310 S TWIN OAKS VALLEY RD SUITE 108
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City | SAN MARCOS
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State | CA
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Zip | 92078-4303
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Country | US
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Telephone | 619-829-6961
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Fax |
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Provider Business Mailing Address
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Address Line | 2096 SUSAN CT
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City | ESCONDIDO
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State | CA
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Zip | 92026-1878
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Country | US
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Telephone | 619-829-6961
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | MR. SHAUN ROLAND BLAKE
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Credential | PT, DPT
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Telephone | 619-829-6961
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | PT38074
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License Number State | CA
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