Provider Demographics
NPI:1366970733
Name:FURR, BRENT ALBERT (PT, DPT)
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:ALBERT
Last Name:FURR
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 N EL CAMINO REAL
Mailing Address - Street 2:STE 210
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-2813
Mailing Address - Country:US
Mailing Address - Phone:619-670-4567
Mailing Address - Fax:619-670-0200
Practice Address - Street 1:10225 AUSTIN DR STE 204
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91978-1522
Practice Address - Country:US
Practice Address - Phone:619-670-4567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-30
Last Update Date:2017-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA293082225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist