Provider Demographics
NPI:1548983901
Name:EMPOWER PHYSICAL THERAPY INC
Entity type:Organization
Organization Name:EMPOWER PHYSICAL THERAPY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER / CEO
Authorized Official - Prefix:
Authorized Official - First Name:IVY
Authorized Official - Middle Name:
Authorized Official - Last Name:COLBERT
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:858-729-3338
Mailing Address - Street 1:11060 AVENIDA DEL GATO
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-1711
Mailing Address - Country:US
Mailing Address - Phone:858-729-3338
Mailing Address - Fax:
Practice Address - Street 1:16776 BERNARDO CENTER DR STE 204A
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2559
Practice Address - Country:US
Practice Address - Phone:858-361-8782
Practice Address - Fax:844-440-1873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-21
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1568014603OtherNPI
CA1437514452OtherNPI
CA1679015994OtherNPI