Healthcare Provider Details

I. General information

NPI: 1538095393
Provider Name (Legal Business Name): AGING WELL MOBILE PHYSICAL AND OCCUPATIONAL THERAPY PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

538 WOODHOUSE AVE
CHULA VISTA CA
91910-7409
US

IV. Provider business mailing address

538 WOODHOUSE AVE
CHULA VISTA CA
91910-7409
US

V. Phone/Fax

Practice location:
  • Phone: 619-347-8150
  • Fax:
Mailing address:
  • Phone: 619-453-2007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL JAMES
Title or Position: PRESIDENT
Credential: PT
Phone: 619-453-2007