Organization
ALPHA PHYSICAL THERAPY AND PERFORMANCE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SHAUN ROLAND BLAKE PT, DPT (PRESIDENT/OWNER)
(619) 829-6961
Entity
Organization
Contact information
Practice address
310 S TWIN OAKS VALLEY RD, SUITE 108, SAN MARCOS, CA 92078-4303
(619) 829-6961
Mailing address
2096 SUSAN CT, ESCONDIDO, CA 92026-1878
(619) 829-6961
Taxonomy
Speciality
Code
Description
License number
State
261QR0400X
Rehabilitation Clinic/Center
Primary
PT38074
CA
Other
Enumeration date
04/17/2014
Last updated
04/17/2014
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