MEDICARE: VITALITY PHYSICAL THERAPY AND WELLNESS

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

General Provider Information

NPI Number	:	1942051826
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VITALITY PHYSICAL THERAPY AND WELLNESS

Provider Business Mailing Address
First Line	:	6422 MALLARD ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92114-1534
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6422 MALLARD ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92114-1534
Country	:	US
Telephone Number	:	510-449-3427
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	CHRISTINA NUNEZ
Credential	:
Telephone Number	:	510-449-3427

Provider Enumeration Date	:	03/29/2024
Last Update Date	:	03/29/2024

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Directions to “VITALITY PHYSICAL THERAPY AND WELLNESS ” Practice Location

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