Basic Information
| Provider Information | |||||||||
| NPI: | 1528274495 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GASPAR PHYSICAL THERAPY A PROFESSIONAL CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 GARDEN VIEW CT | ||||||||
| Address2: | STE 103 | ||||||||
| City: | ENCINITAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920242478 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7606326942 | ||||||||
| FaxNumber: | 7606326819 | ||||||||
| Practice Location | |||||||||
| Address1: | 700 GARDEN VIEW CT | ||||||||
| Address2: | STE 103 | ||||||||
| City: | ENCINITAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920242478 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7606326942 | ||||||||
| FaxNumber: | 7606326819 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2007 | ||||||||
| LastUpdateDate: | 10/12/2016 | ||||||||
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| AuthorizedOfficialLastName: | SNOW | ||||||||
| AuthorizedOfficialFirstName: | ROBER | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7606925142 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.