Provider Demographics
NPI:1538391693
Name:CALSO, JEFFREY G (DPT)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:G
Last Name:CALSO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2212 PICO BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-1720
Mailing Address - Country:US
Mailing Address - Phone:310-393-9292
Mailing Address - Fax:310-393-6693
Practice Address - Street 1:2212 PICO BLVD
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-1720
Practice Address - Country:US
Practice Address - Phone:310-393-9292
Practice Address - Fax:310-393-6693
Is Sole Proprietor?:No
Enumeration Date:2009-08-21
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35946225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist