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General NPI Number Information
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NPI Number | 1447544499
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Entity Type | Organization
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Legal Business Name | POWER PHYSICAL THERAPY AND SPORTS MEDICINE
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Dates
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Enumeration Date | 06/07/2011
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Last Update Date | 06/07/2011
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Provider Practice Location Address
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Address Line | 3140 RED HILL AVE STE 225
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City | COSTA MESA
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State | CA
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Zip | 92626-3440
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Country | US
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Telephone | 714-222-5922
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Fax |
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Provider Business Mailing Address
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Address Line | 2973 HARBOR BLVD # 339
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City | COSTA MESA
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State | CA
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Zip | 92626-3912
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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 | PRESIDENT
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Name | DR. MARK C NOWLIN
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Credential | DPT
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Telephone | 714-222-5922
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT 23889
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License Number State | CA
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