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General NPI Number Information
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NPI Number | 1891093803
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Entity Type | Organization
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Legal Business Name | MYKL CONCEPTS & PHYSIOTHERAPY ,PC
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Dates
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Enumeration Date | 03/01/2011
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Last Update Date | 07/17/2020
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Provider Practice Location Address
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Address Line | 410 S MELROSE DR STE 200
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City | VISTA
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State | CA
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Zip | 92081-6623
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Country | US
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Telephone | 858-229-8178
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Fax | 877-575-2650
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Provider Business Mailing Address
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Address Line | 410 S MELROSE DR STE 200
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City | VISTA
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State | CA
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Zip | 92081-6623
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Country | US
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Telephone | 858-229-8178
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Fax | 877-575-2650
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL SHANNON
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Credential | PT
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Telephone | 858-229-8178
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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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