Healthcare Provider Details

I. General information

NPI: 1558892752
Provider Name (Legal Business Name): MOBILE ORTHOPEDIC PHYSICAL THERAPY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2017
Last Update Date: 01/05/2023
Certification Date: 01/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

885 CANARIOS CT STE 110
CHULA VISTA CA
91910-7877
US

IV. Provider business mailing address

885 CANARIOS CT STE 110
CHULA VISTA CA
91910-7877
US

V. Phone/Fax

Practice location:
  • Phone: 619-656-5102
  • Fax: 619-656-5143
Mailing address:
  • Phone: 619-656-5102
  • Fax: 619-656-5143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT2500
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT24945
License Number StateCA

VIII. Authorized Official

Name: CURTIS HILL
Title or Position: DIRECTOR
Credential: PT
Phone: 619-656-5102