Provider Demographics
NPI:1285729509
Name:PROACTIVE PHYSICAL THERAPY & SPORTS MEDICINE INC
Entity type:Organization
Organization Name:PROACTIVE PHYSICAL THERAPY & SPORTS MEDICINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:DIPAOLA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:480-653-8200
Mailing Address - Street 1:6070 AVENIDA ENCINAS
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-1001
Mailing Address - Country:US
Mailing Address - Phone:760-444-0102
Mailing Address - Fax:760-688-3131
Practice Address - Street 1:6070 AVENIDA ENCINAS
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92011-1001
Practice Address - Country:US
Practice Address - Phone:760-444-0102
Practice Address - Fax:760-688-3131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherTAX ID