Healthcare Provider Details

I. General information

NPI: 1508257213
Provider Name (Legal Business Name): FRANKLIN MAPHIS PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2015
Last Update Date: 02/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1663 GREENFIELD DR
EL CAJON CA
92021-3520
US

IV. Provider business mailing address

2512 MONROE AVE
SAN DIEGO CA
92116-2952
US

V. Phone/Fax

Practice location:
  • Phone: 619-440-4742
  • Fax:
Mailing address:
  • Phone: 619-972-7726
  • Fax: 619-440-6861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number6436
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: