Healthcare Provider Details

I. General information

NPI: 1275994428
Provider Name (Legal Business Name): TOM FLYNN MPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2016
Last Update Date: 03/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15004 INNOVATION DR
SAN DIEGO CA
92128-3491
US

IV. Provider business mailing address

10790 RANCHO BERNARDO RD
SAN DIEGO CA
92127-5705
US

V. Phone/Fax

Practice location:
  • Phone: 858-605-7189
  • Fax:
Mailing address:
  • Phone: 858-927-5775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number17970
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: