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General NPI Number Information
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NPI Number | 1508961400
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Entity Type | Organization
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Legal Business Name | EXECUTIVE WELLNESS
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8 QUAIL RIDGE RD S
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City | ROLLING HILLS
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State | CA
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Zip | 90274-5017
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Country | US
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Telephone | 310-218-2600
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Fax | 310-541-8280
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Provider Business Mailing Address
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Address Line | PO BOX 14155
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City | ORANGE
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State | CA
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Zip | 92863-1555
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Country | US
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Telephone | 310-218-2600
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Fax | 310-541-8280
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Authorized Official
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Title or Position | OWNER
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Name | MR. CASEY EDWARD MAGUIRE
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Credential |
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Telephone | 310-218-2600
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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 |
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License Number State |
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