1679529408 NPI number — EGGLETON & LANGTON PHYSICAL THERAPY MANAGEMENT SERVICES

Table of content: (NPI 1679529408)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679529408 NPI number — EGGLETON & LANGTON PHYSICAL THERAPY MANAGEMENT SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EGGLETON & LANGTON PHYSICAL THERAPY MANAGEMENT SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679529408
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/13/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
317 N EL CAMINO REAL
Provider Second Line Business Mailing Address:
#210
Provider Business Mailing Address City Name:
ENCINITAS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92024-2811
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-634-0248
Provider Business Mailing Address Fax Number:
760-634-1782

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10225 AUSTIN DR
Provider Second Line Business Practice Location Address:
#204
Provider Business Practice Location Address City Name:
SPRING VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91978-1500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-670-4567
Provider Business Practice Location Address Fax Number:
619-670-0200
Provider Enumeration Date:
05/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCKEOWN
Authorized Official First Name:
SEAN
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
619-295-3000

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: ZZZ05346Z . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com