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General NPI Number Information
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NPI Number | 1184938078
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Entity Type | Organization
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Legal Business Name | INDEPENDENCE PHYSICAL THERAPY
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Dates
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Enumeration Date | 08/03/2010
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Last Update Date | 08/03/2010
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Provider Practice Location Address
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Address Line | 24572 MOSQUERO LN
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City | MISSION VIEJO
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State | CA
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Zip | 92691-4911
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Country | US
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Telephone | 949-350-0322
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Fax | 949-597-0758
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Provider Business Mailing Address
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Address Line | 24572 MOSQUERO LN
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City | MISSION VIEJO
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State | CA
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Zip | 92691-4911
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Country | US
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Telephone | 949-350-0322
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Fax | 949-597-0758
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MR. MICHAEL PATRICK BRACKETT
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Credential | P.T.
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Telephone | 949-350-0322
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | PT24421
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License Number State | CA
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