Basic Information
| Provider Information | |||||||||
| NPI: | 1689738627 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NORTH COAST PHYSICAL THERAPY INC | ||||||||
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| OtherOrganizationName: | NORTH COAST PHYSICAL THERAPY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3633 VISTA WAY | ||||||||
| Address2: | 101 | ||||||||
| City: | OCEANSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920564568 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607297298 | ||||||||
| FaxNumber: | 7607297206 | ||||||||
| Practice Location | |||||||||
| Address1: | 3633 VISTA WAY | ||||||||
| Address2: | 101 | ||||||||
| City: | OCEANSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920564568 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607297298 | ||||||||
| FaxNumber: | 7607297206 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2006 | ||||||||
| LastUpdateDate: | 11/25/2019 | ||||||||
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| AuthorizedOfficialLastName: | HAMEL | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICAL THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 7607297298 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PHYSICAL THERAPIST | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | W18003 | 01 | CA | MEDICARE LEGACY # W18003 | OTHER |