Healthcare Provider Details

I. General information

NPI: 1790729424
Provider Name (Legal Business Name): RICHARD KEITH MAHLER PT, MPT, CEAS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 06/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7801 MISSION CENTER CT SUITE 430
SAN DIEGO CA
92108-1313
US

IV. Provider business mailing address

7801 MISSION CENTER CT SUITE 430
SAN DIEGO CA
92108-1313
US

V. Phone/Fax

Practice location:
  • Phone: 619-296-5780
  • Fax: 619-296-5787
Mailing address:
  • Phone: 619-296-5780
  • Fax: 619-296-5787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT 26994
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: