Provider Demographics
NPI:1366995870
Name:LEVEL 4 PHYSICAL THERAPY AND PERFORMANCE, INC.
Entity type:Organization
Organization Name:LEVEL 4 PHYSICAL THERAPY AND PERFORMANCE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:DIMITRIS
Authorized Official - Last Name:ANDALON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:760-503-4440
Mailing Address - Street 1:171 SAXONY RD STE 105
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-6776
Mailing Address - Country:US
Mailing Address - Phone:760-503-4440
Mailing Address - Fax:801-409-2137
Practice Address - Street 1:171 SAXONY RD STE 105
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024
Practice Address - Country:US
Practice Address - Phone:760-503-4440
Practice Address - Fax:801-409-2137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-02
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty