Provider Demographics
NPI:1861765190
Name:LA MESA PHYSICAL THERAPY GROUP, INC.
Entity type:Organization
Organization Name:LA MESA PHYSICAL THERAPY GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:LESTINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-464-1352
Mailing Address - Street 1:5648 LAKE MURRAY BLVD
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-1929
Mailing Address - Country:US
Mailing Address - Phone:619-464-1352
Mailing Address - Fax:619-464-7255
Practice Address - Street 1:5648 LAKE MURRAY BLVD
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-1929
Practice Address - Country:US
Practice Address - Phone:619-464-1352
Practice Address - Fax:619-464-7255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-16
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33613225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty