Provider Demographics
NPI:1235944810
Name:HOME RUN PHYSICAL THERAPY CORP
Entity type:Organization
Organization Name:HOME RUN PHYSICAL THERAPY CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPREITOR
Authorized Official - Prefix:
Authorized Official - First Name:CHLOE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:BELISLE
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:206-999-4954
Mailing Address - Street 1:10398 SCRIPPS POWAY PKWY UNIT 84
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-5134
Mailing Address - Country:US
Mailing Address - Phone:206-999-4954
Mailing Address - Fax:
Practice Address - Street 1:10398 SCRIPPS POWAY PKWY UNIT 84
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-5134
Practice Address - Country:US
Practice Address - Phone:206-999-4954
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-11
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy