Provider Demographics
NPI:1316157381
Name:HERVEY, PAUL DAVID (PT)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:DAVID
Last Name:HERVEY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14246 MATCH POINT DR
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-4905
Mailing Address - Country:US
Mailing Address - Phone:858-679-8265
Mailing Address - Fax:
Practice Address - Street 1:9000 WAKARUSA ST
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3307
Practice Address - Country:US
Practice Address - Phone:619-740-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111292251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic