Healthcare Provider Details

I. General information

NPI: 1962267005
Provider Name (Legal Business Name): FORTIFIED PHYSIO INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2024
Last Update Date: 02/19/2024
Certification Date: 02/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 COMMERCE CT
CHICO CA
95928-7114
US

IV. Provider business mailing address

PO BOX 1590
PARADISE CA
95967-1590
US

V. Phone/Fax

Practice location:
  • Phone: 530-774-3283
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KELSEY MOSIER
Title or Position: CEO/PRESIDENT
Credential: DPT
Phone: 530-774-3283