Basic Information
| Provider Information | |||||||||
| NPI: | 1841423613 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GASPAR PHYSICAL THERAPY A PROFESSIONAL CORPORATION | ||||||||
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| OtherOrganizationName: | DAGOSTINO PHYSICAL THERAPY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 GARDEN VIEW CT | ||||||||
| Address2: | STE 103 | ||||||||
| City: | ENCINITAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920242478 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7606925142 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3809 PLAZA DR | ||||||||
| Address2: | STE 112 | ||||||||
| City: | OCEANSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920564625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7609412630 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2009 | ||||||||
| LastUpdateDate: | 10/11/2016 | ||||||||
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| AuthorizedOfficialLastName: | SNOW | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7606925142 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DPT | ||||||||
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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 |
No ID Information.