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General NPI Number Information
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NPI Number | 1912732397
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Entity Type | Organization
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Legal Business Name | OSIDE PHYSICAL THERAPY PC
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Dates
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Enumeration Date | 09/04/2024
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Last Update Date | 09/04/2024
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Provider Practice Location Address
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Address Line | 3320 MISSION AVE STE H
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City | OCEANSIDE
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State | CA
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Zip | 92058-1332
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Country | US
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Telephone | 760-585-4885
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Fax | 760-585-1194
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Provider Business Mailing Address
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Address Line | 3320 MISSION AVE STE H
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City | OCEANSIDE
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State | CA
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Zip | 92058-1332
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Country | US
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Telephone | 760-585-4885
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST
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Name | SEAN MANDELL
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Credential | DPT
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Telephone | 760-585-4885
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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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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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