Provider Demographics
NPI:1598799561
Name:EL CAJON THERAPY ASSOCIATES, INC
Entity type:Organization
Organization Name:EL CAJON THERAPY ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:ASTA
Authorized Official - Last Name:KRUEGER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:619-444-6113
Mailing Address - Street 1:590 S MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-6011
Mailing Address - Country:US
Mailing Address - Phone:619-444-6113
Mailing Address - Fax:619-444-8205
Practice Address - Street 1:590 S MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-6011
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:2006-07-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT5391261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WPT5391AMedicare ID - Type Unspecified