Provider Demographics
NPI:1528274495
Name:GASPAR PHYSICAL THERAPY A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:GASPAR PHYSICAL THERAPY A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBER
Authorized Official - Middle Name:
Authorized Official - Last Name:SNOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-692-5142
Mailing Address - Street 1:700 GARDEN VIEW CT
Mailing Address - Street 2:STE 103
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-2478
Mailing Address - Country:US
Mailing Address - Phone:760-632-6942
Mailing Address - Fax:760-632-6819
Practice Address - Street 1:700 GARDEN VIEW CT
Practice Address - Street 2:STE 103
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2478
Practice Address - Country:US
Practice Address - Phone:760-632-6942
Practice Address - Fax:760-632-6819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14625Medicare ID - Type Unspecified