MEDICARE: PHYSICAL THERAPY IN-HOME 4U INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1194202184
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICAL THERAPY IN-HOME 4U INC

Provider Business Mailing Address
First Line	:	5213 MOUNT ALIFAN DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-2620
Country	:	US
Telephone Number	:	619-467-9467
Fax Number	:

Provider Business Practice Location Address
First Line	:	5213 MOUNT ALIFAN DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-2620
Country	:	US
Telephone Number	:	619-467-9467
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	JOHAN VERMAAS
Credential	:	BACHELOR
Telephone Number	:	619-467-9467

Provider Enumeration Date	:	07/23/2018
Last Update Date	:	08/07/2024

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