Healthcare Provider Details

I. General information

NPI: 1134175169
Provider Name (Legal Business Name): MC PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2082 POINTE PKWY
SPRING VALLEY CA
91978-2018
US

IV. Provider business mailing address

2082 POINTE PKWY
SPRING VALLEY CA
91978-2018
US

V. Phone/Fax

Practice location:
  • Phone: 619-838-6158
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MS. MICHELE KATHERINE CAZALAS
Title or Position: OWNER
Credential: PT
Phone: 619-838-6158