Basic Information
| Provider Information | |||||||||
| NPI: | 1831165323 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DAGOSTINO PHYSICAL THERAPY INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3809 PLAZA DR | ||||||||
| Address2: | STE 112 | ||||||||
| City: | OCEANSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920564625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7609412630 | ||||||||
| FaxNumber: | 7609414617 | ||||||||
| Practice Location | |||||||||
| Address1: | 3809 PLAZA DR | ||||||||
| Address2: | STE 112 | ||||||||
| City: | OCEANSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920564625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7609412630 | ||||||||
| FaxNumber: | 7609414617 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/24/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | DAGOSTINO | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | JOSEPH | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7609412630 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | DPT PT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | DC2386 | 01 | CA | MEDICARE RAILROAD | OTHER |