Basic Information
| Provider Information | |||||||||
| NPI: | 1366970733 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FURR | ||||||||
| FirstName: | BRENT | ||||||||
| MiddleName: | ALBERT | ||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 317 N EL CAMINO REAL | ||||||||
| Address2: | STE 210 | ||||||||
| City: | ENCINITAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920242813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6196704567 | ||||||||
| FaxNumber: | 6196700200 | ||||||||
| Practice Location | |||||||||
| Address1: | 10225 AUSTIN DR STE 204 | ||||||||
| Address2: | |||||||||
| City: | SPRING VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919781522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6196704567 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2017 | ||||||||
| LastUpdateDate: | 07/27/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 293082 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.