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General NPI Number Information
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NPI Number | 1457014896
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Entity Type | Organization
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Legal Business Name | MY PHYSIO FOR LIFE
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Dates
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Enumeration Date | 10/21/2021
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Last Update Date | 10/14/2024
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Provider Practice Location Address
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Address Line | 3600 OCEAN RANCH BLVD
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City | OCEANSIDE
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State | CA
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Zip | 92056-2669
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Country | US
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Telephone | 760-696-3373
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Fax | 877-559-5308
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Provider Business Mailing Address
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Address Line | 3600 OCEAN RANCH BLVD
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City | OCEANSIDE
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State | CA
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Zip | 92056-2669
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Country | US
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Telephone | 760-696-3373
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Fax | 877-559-5308
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | CAROLYN BOWE-MCLEOD
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Credential |
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Telephone | 760-433-7944
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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 |
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License Number State |
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Taxonomy #2
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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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