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General NPI Number Information
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NPI Number | 1649691932
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Entity Type | Organization
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Legal Business Name | MB PHYSICAL THERAPY PC
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Dates
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Enumeration Date | 01/03/2014
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Last Update Date | 01/03/2014
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Provider Practice Location Address
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Address Line | 2010 WILSHIRE BLVD STE 809
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City | LOS ANGELES
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State | CA
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Zip | 90057-3594
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Country | US
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Telephone | 213-252-1985
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Fax |
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Provider Business Mailing Address
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Address Line | 32061 CAMINO DEL CIELO
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City | TRABUCO CANYON
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State | CA
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Zip | 92679-3440
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Country | US
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Telephone | 949-330-3832
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MATT SKALAK
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Credential | DPT
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Telephone | 949-330-3832
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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 | PT36431
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License Number State | CA
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