Provider Demographics
NPI:1124520812
Name:DAWSON, JOHN (PT, DPT, CSCS, TPI)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:DAWSON
Suffix:
Gender:M
Credentials:PT, DPT, CSCS, TPI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3066 N PARK WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-3625
Mailing Address - Country:US
Mailing Address - Phone:925-219-2621
Mailing Address - Fax:
Practice Address - Street 1:510 HACIENDA DR STE 107
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-6639
Practice Address - Country:US
Practice Address - Phone:760-630-8060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-08
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2946122251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic