Basic Information
| Provider Information | |||||||||
| NPI: | 1285829374 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GASPAR PHYSICAL THERAPY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7760 EL CAMINO REAL | ||||||||
| Address2: | STE A | ||||||||
| City: | CARLSBAD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920090000 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 7760 EL CAMINO REAL | ||||||||
| Address2: | STE A | ||||||||
| City: | CARLSBAD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920098553 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7606349750 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2007 | ||||||||
| LastUpdateDate: | 09/11/2007 | ||||||||
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| AuthorizedOfficialLastName: | WARD | ||||||||
| AuthorizedOfficialFirstName: | CRISTOPHER | ||||||||
| AuthorizedOfficialMiddleName: | AUGUST | ||||||||
| AuthorizedOfficialTitleorPosition: | ATHLETIC TRAINER | ||||||||
| AuthorizedOfficialTelephone: | 8586923437 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | ATC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251K00000X | CA | Y | Agencies | Public Health or Welfare |
No ID Information.