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General NPI Number Information
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NPI Number | 1891277042
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Entity Type | Organization
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Legal Business Name | ADVANCED INTEGRATIVE MANUAL THERAPY
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Dates
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Enumeration Date | 09/04/2018
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Last Update Date | 09/04/2018
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Provider Practice Location Address
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Address Line | 1532 NEWPORT BLVD
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City | COSTA MESA
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State | CA
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Zip | 92627
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Country | US
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Telephone | 949-877-6547
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Fax |
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Provider Business Mailing Address
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Address Line | 1532 NEWPORT BLVD
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City | COSTA MESA
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State | CA
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Zip | 92627-3715
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Country | US
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Telephone | 949-877-6547
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Fax |
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Authorized Official
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Title or Position | OWNER/NEUROMUSCULAR THERAPIST
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Name | WILLIAM TURK
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Credential | CMT
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Telephone | 949-877-6547
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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