Basic Information
| Provider Information | |||||||||
| NPI: | 1609165091 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BAYSPORT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12000 CARMEL COUNTRY RD | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921306101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8585099600 | ||||||||
| FaxNumber: | 8585099611 | ||||||||
| Practice Location | |||||||||
| Address1: | 12000 CARMEL COUNTRY RD | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921306101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8585099600 | ||||||||
| FaxNumber: | 8585099611 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2011 | ||||||||
| LastUpdateDate: | 04/06/2011 | ||||||||
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| AuthorizedOfficialLastName: | EMERY | ||||||||
| AuthorizedOfficialFirstName: | LINDA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | VP/ CFO | ||||||||
| AuthorizedOfficialTelephone: | 4083957300 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | PT27751 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.