Basic Information
| Provider Information | |||||||||
| NPI: | 1366025819 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | EVEREST MOBILE PHYSICAL THERAPY CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2305 HISTORIC DECATUR RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921066071 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7602094868 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2305 HISTORIC DECATUR RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921066071 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7602094868 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2021 | ||||||||
| LastUpdateDate: | 05/03/2021 | ||||||||
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| AuthorizedOfficialLastName: | LUK | ||||||||
| AuthorizedOfficialFirstName: | CARMEN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PT, DPT | ||||||||
| AuthorizedOfficialTelephone: | 7602094868 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PHYSICAL THERAPIST | ||||||||
| NPICertificationDate: | 05/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.