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NPI Code Detail

MEDICARE: JEE-HAE J SON P.T.

MEDICARE: JEE-HAE J SON P.T.
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
1225100000XPhysical TherapistPT 26191CA

General Provider Information

NPI Number : 1194908905
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEE-HAE J SON P.T.
Provider Business Mailing Address
First Line : 317 N EL CAMINO REAL
Second Line : #210
City : ENCINITAS
State : CA
Zip : 92024-2811
Country : US
Telephone Number : 760-634-0248
Fax Number : 760-634-1782
Provider Business Practice Location Address
First Line : 4435 EASTGATE MALL
Second Line : #120
City : SAN DIEGO
State : CA
Zip : 92121-1982
Country : US
Telephone Number : 858-587-8669
Fax Number : 858-587-8675
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/14/2007
Last Update Date : 04/27/2015

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Directions to “ JEE-HAE J SON P.T.” Practice Location

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