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General NPI Number Information
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NPI Number | 1053733220
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Entity Type | Organization
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Legal Business Name | DOC & DEVO, INC.
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Dates
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Enumeration Date | 01/07/2014
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Last Update Date | 06/23/2014
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Provider Practice Location Address
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Address Line | 26522 LA ALAMEDA STE 100
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City | MISSION VIEJO
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State | CA
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Zip | 92691-8579
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Country | US
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Telephone | 949-582-2555
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Fax |
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Provider Business Mailing Address
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Address Line | 26522 LA ALAMEDA STE 100
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City | MISSION VIEJO
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State | CA
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Zip | 92691-8579
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Country | US
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Telephone | 949-582-2555
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Fax | 949-582-3567
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Authorized Official
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Title or Position | PHYSICAL THERAPIST/OWNER
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Name | KYLE LOUIS ULRICH
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Credential | PT, DPT
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Telephone | 949-582-2555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT34242
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License Number State | CA
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