Healthcare Provider Details

I. General information

NPI: 1407681513
Provider Name (Legal Business Name): MACH ONE REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2024
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 COYOTE DR
MURPHYS CA
95247-9339
US

IV. Provider business mailing address

1601 COYOTE DR
MURPHYS CA
95247-9339
US

V. Phone/Fax

Practice location:
  • Phone: 951-640-3638
  • Fax:
Mailing address:
  • Phone: 951-640-3638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE AN MACH
Title or Position: CEO
Credential: PT
Phone: 951-640-3638