Provider Demographics
NPI:1154779759
Name:GASPAR PHYSICAL THERAPY A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:GASPAR PHYSICAL THERAPY A PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:SNOW
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:760-634-9750
Mailing Address - Street 1:700 GARDEN VIEW COURT
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-2404
Mailing Address - Country:US
Mailing Address - Phone:760-632-6942
Mailing Address - Fax:760-632-6819
Practice Address - Street 1:13350 CAMINO DEL SUR
Practice Address - Street 2:SUITE 1
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92129-4473
Practice Address - Country:US
Practice Address - Phone:760-634-9750
Practice Address - Fax:760-634-9752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-25
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty