MEDICARE: AGILE OCCUPATIONAL MEDICINE, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center
2	261QX0100X	Occupational Medicine Clinic/Center

General Provider Information

NPI Number	:	1740915008
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGILE OCCUPATIONAL MEDICINE, PC

Provider Business Mailing Address
First Line	:	3200 BRISTOL ST STE 600
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92626-1810
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	445 E ANAHEIM ST
Second Line	:
City	:	WILMINGTON
State	:	CA
Zip	:	90744-4600
Country	:	US
Telephone Number	:	562-267-3798
Fax Number	:

Authorized Official
Title or Position	:	SECRETARY
Name	:	PETER MURRAY
Credential	:
Telephone Number	:	571-224-5886

Provider Enumeration Date	:	07/20/2022
Last Update Date	:	05/05/2026

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