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Organization
PROACTIVE PHYSICAL THERAPY & SPORTS MEDICINE
Active
Organization
PROACTIVE PHYSICAL THERAPY & SPORTS MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACK PENTLARGE (OWNER)
(760) 444-0102
Entity
Organization
Contact information
Practice address
10806 WILLOW CT, SAN DIEGO, CA 92127-2428
(858) 381-5084
Mailing address
6070 AVENIDA ENCINAS, CARLSBAD, CA 92011-1001
(760) 444-0102
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
06/11/2008
Last updated
06/11/2008
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