Provider Demographics
NPI:1194495762
Name:MURCIA, JUAN PABLO (PT, DPT)
Entity type:Individual
Prefix:
First Name:JUAN PABLO
Middle Name:
Last Name:MURCIA
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 S CEDROS AVE
Mailing Address - Street 2:
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-1924
Mailing Address - Country:US
Mailing Address - Phone:714-316-4388
Mailing Address - Fax:
Practice Address - Street 1:6884 EMBARCADERO LN
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92011-3227
Practice Address - Country:US
Practice Address - Phone:760-301-6566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300743225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist