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General NPI Number Information
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NPI Number | 1881290468
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Entity Type | Organization
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Legal Business Name | TRIPHYSIO LLC
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Dates
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Enumeration Date | 12/08/2020
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Last Update Date | 02/10/2024
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Provider Practice Location Address
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Address Line | 4340 GENESEE AVE STE 210
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City | SAN DIEGO
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State | CA
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Zip | 92117-4940
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Country | US
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Telephone | 858-997-7638
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Fax |
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Provider Business Mailing Address
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Address Line | 8240 STATION VILLAGE LN APT 2105
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City | SAN DIEGO
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State | CA
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Zip | 92108-5588
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Country | US
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Telephone | 858-997-7638
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | RUSSELL O BAUTISTA
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Credential | PT
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Telephone | 858-997-7638
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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