Basic Information
| Provider Information | |||||||||
| NPI: | 1881631505 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EGGLETON & LANGTON PHYSICAL THERAPY MANAGEMENT SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5962 LA PLACE CT | ||||||||
| Address2: | STE 170 | ||||||||
| City: | CARLSBAD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920088807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8009294776 | ||||||||
| FaxNumber: | 7609318370 | ||||||||
| Practice Location | |||||||||
| Address1: | 5030 CAMINO DE LA SIESTA | ||||||||
| Address2: | #105 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921083116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192946088 | ||||||||
| FaxNumber: | 6192206871 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2006 | ||||||||
| LastUpdateDate: | 02/13/2018 | ||||||||
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| AuthorizedOfficialLastName: | MCKEOWN | ||||||||
| AuthorizedOfficialFirstName: | SEAN | ||||||||
| AuthorizedOfficialMiddleName: | MICHAEL | ||||||||
| AuthorizedOfficialTitleorPosition: | AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 6192953000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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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 | ZZZ05344Z | 01 | CA | BLUE SHIELD | OTHER |