Provider Demographics
NPI:1194899385
Name:EL CAJON THERAPY ASSOCIATES
Entity type:Organization
Organization Name:EL CAJON THERAPY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:IANNAZZO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:619-444-6113
Mailing Address - Street 1:1201 AVOCADO AVE PMB 189
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-7704
Mailing Address - Country:US
Mailing Address - Phone:619-444-6113
Mailing Address - Fax:619-444-8205
Practice Address - Street 1:198 W MAIN ST
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-3399
Practice Address - Country:US
Practice Address - Phone:619-444-6113
Practice Address - Fax:619-444-8205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT5391225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty