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General NPI Number Information
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NPI Number | 1477989887
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Entity Type | Organization
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Legal Business Name | MOISAN PHYSICAL THERAPY AND WELLNESS, INC
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Dates
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Enumeration Date | 09/17/2013
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Last Update Date | 09/17/2013
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Provider Practice Location Address
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Address Line | 302 N EL CAMINO REAL STE 106
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City | SAN CLEMENTE
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State | CA
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Zip | 92672-4776
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Country | US
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Telephone | 949-310-3292
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Fax |
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Provider Business Mailing Address
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Address Line | 302 N EL CAMINO REAL STE 106
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City | SAN CLEMENTE
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State | CA
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Zip | 92672-4776
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Country | US
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Telephone | 949-310-3292
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CONSTANCE MOISAN
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Credential | DPT
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Telephone | 949-310-3292
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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 | PT35727
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License Number State | CA
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