Alpha Physical Therapy and Performance, Inc

Primary specialty

Rehabilitation Clinic/CenterTaxonomy code 261QR0400X

License

PT38074 Issued in CA

Legal business name

ALPHA PHYSICAL THERAPY AND PERFORMANCE, INC

Practice address

310 S Twin Oaks Valley Rd
Suite 108
San Marcos, CA 92078-4303

Phone

(619) 829-6961

NPI assigned

Apr 17, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Shaun Roland Blake, PT, DPT

Title

President/Owner

Phone

(619) 829-6961

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1397692800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1397692800000",
    "number": "1841610847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2096 SUSAN CT",
            "city": "ESCONDIDO",
            "state": "CA",
            "postal_code": "920261878",
            "telephone_number": "619-829-6961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 S TWIN OAKS VALLEY RD",
            "address_2": "SUITE 108",
            "city": "SAN MARCOS",
            "state": "CA",
            "postal_code": "920784303",
            "telephone_number": "619-829-6961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALPHA PHYSICAL THERAPY AND PERFORMANCE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-17",
        "last_updated": "2014-04-17",
        "status": "A",
        "authorized_official_last_name": "BLAKE",
        "authorized_official_first_name": "SHAUN",
        "authorized_official_middle_name": "ROLAND",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "619-829-6961",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT, DPT"
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": "CA",
            "license": "PT38074",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Rehabilitation Clinic/Center in San Marcos, CA
• Providers in San Marcos, CA by specialty
• Rehabilitation Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.