Basic Information
Provider Information
NPI: 1891748059
EntityType: 2
ReplacementNPI:  
OrganizationName: WEST COAST PHYSICAL THERAPY, INC
LastName:  
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OtherOrganizationName: WEST COAST PHYSICAL THERAPY
OtherOrganizationType: 3
OtherLastName:  
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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: 27882 FORBES RD
Address2: #110
City: LAGUNA NIGUEL
State: CA
PostalCode: 926771267
CountryCode: US
TelephoneNumber: 9493642955
FaxNumber: 9493641799
Other Information
ProviderEnumerationDate: 05/18/2006
LastUpdateDate: 09/27/2007
NPIDeactivationReasonCode:  
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AuthorizedOfficialLastName: LASSON
AuthorizedOfficialFirstName: ANNE
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: VICE PRESIDENT
AuthorizedOfficialTelephone: 4085700510
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
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NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000XPT 24601CAY193200000X MULTI-SPECIALTY GROUPRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

ID Information
IDTypeStateIssuerDescription
ZZZ08070Z01CABLUE SHIELDOTHER
3386901CAFIRST HEALTHOTHER


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