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General NPI Number Information
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NPI Number | 1669011177
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Entity Type | Organization
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Legal Business Name | TOTAL MOTION SPORTS THERAPY
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Dates
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Enumeration Date | 12/31/2019
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Last Update Date | 12/31/2019
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Provider Practice Location Address
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Address Line | 808 ADAMS AVE
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92648-3214
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Country | US
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Telephone | 714-369-9328
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Fax |
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Provider Business Mailing Address
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Address Line | 8941 ATLANTA AVE # 355
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92646-7121
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Country | US
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Telephone | 714-369-9328
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | JAKE GILBERT
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Credential | PTA
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Telephone | 714-369-9328
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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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