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General NPI Number Information
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NPI Number | 1790334878
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Entity Type | Organization
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Legal Business Name | FYZIOGYM PHYSICAL THERAPY OF CALIFORNIA CORP
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Dates
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Enumeration Date | 09/10/2019
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Last Update Date | 09/10/2019
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Provider Practice Location Address
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Address Line | 16331 GOTHARD ST
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92647-3664
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Country | US
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Telephone | 714-690-0385
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Fax |
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Provider Business Mailing Address
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Address Line | 711 PACIFIC COAST HWY UNIT 323
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92648-5053
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Country | US
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Telephone | 814-881-4717
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LYNEIL MITCHELL
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Credential | PT
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Telephone | 814-881-4717
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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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