| NPI | 1073613527 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN DEE TOLLEFSON Owner 619-497-1890 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT14065) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT10276) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2020-08-22 |