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General NPI Number Information
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NPI Number | 1255850293
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Entity Type | Organization
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Legal Business Name | CENTER FOR OPTIMAL MOVEMENT
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Dates
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Enumeration Date | 09/11/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 6125 PASEO DEL NORTE STE 100
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City | CARLSBAD
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State | CA
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Zip | 92011-1113
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Country | US
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Telephone | 760-909-2355
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Fax | 760-448-5363
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Provider Business Mailing Address
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Address Line | 6125 PASEO DEL NORTE STE 100
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City | CARLSBAD
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State | CA
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Zip | 92011-1113
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Country | US
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Telephone | 760-909-2355
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Fax | 760-448-5363
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NEIL MCKENNA
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Credential | DPT
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Telephone | 760-909-2355
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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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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 25475
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 25475
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License Number State | CA
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