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General NPI Number Information
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NPI Number | 1396234449
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Entity Type | Organization
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Legal Business Name | MAVERICK PHYSICAL THERAPY P.C.
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Dates
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Enumeration Date | 05/04/2018
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Last Update Date | 08/06/2025
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Provider Practice Location Address
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Address Line | 5915 MIRA MESA BLVD STE D
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City | SAN DIEGO
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State | CA
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Zip | 92121-4303
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Country | US
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Telephone | 858-899-8299
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Fax |
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Provider Business Mailing Address
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Address Line | 5915 MIRA MESA BLVD STE D
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City | SAN DIEGO
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State | CA
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Zip | 92121-4303
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Country | US
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Telephone | 858-899-8299
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARK FRENS
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Credential |
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Telephone | 616-889-6894
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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 | PT41485
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License Number State | CA
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