MEDICARE: DAGOSTINO PHYSICAL THERAPY 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	225100000X	Physical Therapist

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DC2386	OTHER	CA	MEDICARE RAILROAD

General Provider Information

NPI Number	:	1831165323
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAGOSTINO PHYSICAL THERAPY INC

Provider Business Mailing Address
First Line	:	3809 PLAZA DR
Second Line	:	STE 112
City	:	OCEANSIDE
State	:	CA
Zip	:	92056-4625
Country	:	US
Telephone Number	:	760-941-2630
Fax Number	:	760-941-4617

Provider Business Practice Location Address
First Line	:	3809 PLAZA DR
Second Line	:	STE 112
City	:	OCEANSIDE
State	:	CA
Zip	:	92056-4625
Country	:	US
Telephone Number	:	760-941-2630
Fax Number	:	760-941-4617

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JAMES JOSEPH DAGOSTINO
Credential	:	DPT PT
Telephone Number	:	760-941-2630

Provider Enumeration Date	:	02/24/2006
Last Update Date	:	08/22/2020

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Directions to “DAGOSTINO PHYSICAL THERAPY INC ” Practice Location

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