Provider Demographics
NPI:1245847540
Name:BESPOKE SAN DIEGO PHYSICAL THERAPY PC
Entity type:Organization
Organization Name:BESPOKE SAN DIEGO PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BILLING/COLLECTIONS
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:GUSKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-596-7427
Mailing Address - Street 1:2748 ARIANE DR
Mailing Address - Street 2:UNIT 141
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-3407
Mailing Address - Country:US
Mailing Address - Phone:509-294-5289
Mailing Address - Fax:646-358-3443
Practice Address - Street 1:2748 ARIANE DR
Practice Address - Street 2:UNIT 141
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-3407
Practice Address - Country:US
Practice Address - Phone:509-294-5289
Practice Address - Fax:646-358-3443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-30
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy