Healthcare Provider Details

I. General information

NPI: 1457014896
Provider Name (Legal Business Name): MY PHYSIO FOR LIFE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2021
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 OCEAN RANCH BLVD
OCEANSIDE CA
92056-2669
US

IV. Provider business mailing address

3600 OCEAN RANCH BLVD
OCEANSIDE CA
92056-2669
US

V. Phone/Fax

Practice location:
  • Phone: 760-696-3373
  • Fax: 877-559-5308
Mailing address:
  • Phone: 760-696-3373
  • Fax: 877-559-5308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CAROLYN BOWE-MCLEOD
Title or Position: BILLING MANAGER
Credential:
Phone: 760-433-7944