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General NPI Number Information
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NPI Number | 1184170995
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Entity Type | Organization
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Legal Business Name | MIND BODY PHYSICAL THERAPY P.C.
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Dates
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Enumeration Date | 08/31/2016
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Last Update Date | 04/10/2024
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Provider Practice Location Address
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Address Line | 459 S CHINA LAKE BLVD STE H
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City | RIDGECREST
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State | CA
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Zip | 93555-4685
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Country | US
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Telephone | 760-371-1606
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Fax | 760-264-4405
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Provider Business Mailing Address
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Address Line | 459 S CHINA LAKE BLVD STE H
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City | RIDGECREST
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State | CA
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Zip | 93555-4685
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Country | US
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Telephone | 530-314-3971
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Fax | 530-725-4500
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTINA CHANDRA FROHLICH
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Credential |
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Telephone | 530-541-7133
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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 | 38239
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License Number State | CA
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