Healthcare Provider Details

I. General information

NPI: 1689852899
Provider Name (Legal Business Name): TRAVIS JAMES MORISOLI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2008
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 EL CAMINO REAL STE 100
TUSTIN CA
92780-3655
US

IV. Provider business mailing address

2790 HARBOR BLVD STE 300
COSTA MESA CA
92626-5157
US

V. Phone/Fax

Practice location:
  • Phone: 714-485-7642
  • Fax: 714-838-7099
Mailing address:
  • Phone: 714-485-7642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number34431
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number34431
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: