Healthcare Provider Details

I. General information

NPI: 1992659304
Provider Name (Legal Business Name): MIKAYLA LYNN REMIJIO PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2026
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

906 GLENNEYRE ST
LAGUNA BEACH CA
92651-2707
US

IV. Provider business mailing address

906 GLENNEYRE ST
LAGUNA BEACH CA
92651-2707
US

V. Phone/Fax

Practice location:
  • Phone: 949-494-2046
  • Fax: 949-494-2043
Mailing address:
  • Phone: 949-494-2046
  • Fax: 949-494-2043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number309801
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: