Healthcare Provider Details

I. General information

NPI: 1023920360
Provider Name (Legal Business Name): LUCID MOVEMENT PHYSICAL THERAPY CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2588 PROGRESS ST
VISTA CA
92081-8400
US

IV. Provider business mailing address

1051 CHELSEA CT
VISTA CA
92084-7052
US

V. Phone/Fax

Practice location:
  • Phone: 760-715-4612
  • Fax:
Mailing address:
  • Phone: 760-715-4612
  • 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: AMY SIMPSON
Title or Position: RCM
Credential:
Phone: 760-224-1330