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General NPI Number Information
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NPI Number | 1164000949
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Entity Type | Individual
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Provider Name | GARRETT MICHAEL JAY
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Gender | Male
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Dates
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Enumeration Date | 04/01/2021
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Last Update Date | 04/01/2021
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Provider Practice Location Address
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Address Line | 17272 NEWHOPE ST STE G
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-4210
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Country | US
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Telephone | 714-754-7268
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Fax |
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Provider Business Mailing Address
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Address Line | 3301 MICHELSON DR APT 1114
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City | IRVINE
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State | CA
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Zip | 92612-8800
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | PT299964
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License Number State | CA
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