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General NPI Number Information
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NPI Number | 1215753751
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Entity Type | Organization
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Legal Business Name | ELITE MOBILITY PHYSICAL THERAPY
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Dates
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Enumeration Date | 11/30/2024
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Last Update Date | 01/08/2025
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Provider Practice Location Address
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Address Line | 22431 ANTONIO PKWY # B160-673
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City | RANCHO SANTA MARGARITA
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State | CA
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Zip | 92688-2804
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Country | US
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Telephone | 949-749-2749
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Fax |
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Provider Business Mailing Address
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Address Line | 22431 ANTONIO PKWY # B160-673
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City | RANCHO SANTA MARGARITA
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State | CA
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Zip | 92688-2804
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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 | OWNER, PHYSICAL THERAPIST
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Name | SHAYNA SLATER
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Credential | PT, DPT, OCS, CSCS
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Telephone | 949-749-2749
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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 |
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License Number State |
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