Healthcare Provider Details

I. General information

NPI: 1649202409
Provider Name (Legal Business Name): MICHAEL SCOTT OSBORNE PHYSICAL THERAPY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 04/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2306 DEAN ST
EUREKA CA
95501-3209
US

IV. Provider business mailing address

2306 DEAN ST
EUREKA CA
95501-3209
US

V. Phone/Fax

Practice location:
  • Phone: 707-443-8354
  • Fax: 707-443-8628
Mailing address:
  • Phone: 707-443-8354
  • Fax: 707-443-8628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberPT 10406
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: