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NPI Code Detail

MEDICARE: JANE M. MITSUMORI PT

MEDICARE: JANE M. MITSUMORI PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12251X0800XOrthopedic Physical TherapistPT10043CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PT10043OTHERCASTATE LICENSE #

General Provider Information

NPI Number : 1073636478
Entity Type Code : Individual
Provider Name (Legal Business Name) : JANE M. MITSUMORI PT
Provider Business Mailing Address
First Line : 9122 ADAMS AVE
Second Line :
City : HUNTINGTON BEACH
State : CA
Zip : 92646-3405
Country : US
Telephone Number : 714-962-1780
Fax Number : 714-378-5166
Provider Business Practice Location Address
First Line : 9122 ADAMS AVE
Second Line :
City : HUNTINGTON BEACH
State : CA
Zip : 92646-3405
Country : US
Telephone Number : 714-962-1780
Fax Number : 714-378-5166
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/09/2007
Last Update Date : 12/12/2016

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