Provider Demographics
NPI:1942591904
Name:SAN ELIJO PILATES AND PHYSICAL THERAPY, INC
Entity type:Organization
Organization Name:SAN ELIJO PILATES AND PHYSICAL THERAPY, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:RAINEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:760-512-0908
Mailing Address - Street 1:663 S RANCHO SANTA FE RD
Mailing Address - Street 2:SUITE 144
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-3973
Mailing Address - Country:US
Mailing Address - Phone:760-512-0908
Mailing Address - Fax:760-683-3072
Practice Address - Street 1:2210 ENCINITAS BLVD
Practice Address - Street 2:SUITE G-2
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-4358
Practice Address - Country:US
Practice Address - Phone:760-512-0908
Practice Address - Fax:760-683-3072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-26
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29142225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty