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General NPI Number Information
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NPI Number | 1063025484
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Entity Type | Organization
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Legal Business Name | MAMMOTH PHYSICAL THERAPY
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Dates
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Enumeration Date | 08/25/2020
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Last Update Date | 06/04/2021
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Provider Practice Location Address
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Address Line | 645 OLD MAMMOTH RD STE 9
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City | MAMMOTH LAKES
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State | CA
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Zip | 93546-2048
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Country | US
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Telephone | 760-965-9465
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8963
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City | MAMMOTH LAKES
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State | CA
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Zip | 93546-8963
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Country | US
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Telephone | 707-832-9719
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | MELISSA LYNN BUEHLER
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Credential | PT, DPT
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Telephone | 707-832-9719
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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 |
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License Number State |
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