Healthcare Provider Details

I. General information

NPI: 1912732397
Provider Name (Legal Business Name): OSIDE PHYSICAL THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2024
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3320 MISSION AVE STE H
OCEANSIDE CA
92058-1332
US

IV. Provider business mailing address

3320 MISSION AVE STE H
OCEANSIDE CA
92058-1332
US

V. Phone/Fax

Practice location:
  • Phone: 760-585-4885
  • Fax: 760-585-1194
Mailing address:
  • Phone: 760-585-4885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: SEAN MANDELL
Title or Position: OWNER/PHYSICAL THERAPIST
Credential: DPT
Phone: 760-585-4885