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General NPI Number Information
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NPI Number | 1043089337
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Entity Type | Organization
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Legal Business Name | ADVANCED TRAVEL HEALTH LLC
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Dates
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Enumeration Date | 12/27/2023
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Last Update Date | 12/29/2023
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Provider Practice Location Address
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Address Line | 6915 FLANDERS DR STE D
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City | SAN DIEGO
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State | CA
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Zip | 92121-2987
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Country | US
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Telephone | 858-265-7727
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Fax |
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Provider Business Mailing Address
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Address Line | 6915 FLANDERS DR STE D
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City | SAN DIEGO
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State | CA
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Zip | 92121-2987
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO, PHYSICAL THERAPIST
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Name | OWEN MICHAEL JOHNSTON
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Credential | DPT
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Telephone | 858-265-7727
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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