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General NPI Number Information
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NPI Number | 1487829933
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Entity Type | Individual
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Provider Name | PAUL ROBERT ADDISON JR. MPT, CSCS
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Gender | Male
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Dates
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Enumeration Date | 04/25/2008
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Last Update Date | 02/20/2009
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Provider Practice Location Address
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Address Line | 26941 CABOT RD #103
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-7030
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Country | US
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Telephone | 949-916-1402
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Fax | 949-916-1403
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Provider Business Mailing Address
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Address Line | 26941 CABOT RD #103
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-7030
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Country | US
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Telephone | 949-916-1402
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Fax | 949-916-1403
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 34602
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License Number State | CA
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