Healthcare Provider Details

I. General information

NPI: 1730094095
Provider Name (Legal Business Name): MICHAEL F CLYBURN PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23623 SUNNYMEAD BLVD STE E
MORENO VALLEY CA
92553-3083
US

IV. Provider business mailing address

23623 SUNNYMEAD BLVD STE E
MORENO VALLEY CA
92553-3083
US

V. Phone/Fax

Practice location:
  • Phone: 951-221-3250
  • Fax:
Mailing address:
  • Phone: 951-221-3250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number310760
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: