MEDICARE: MOWBS PHYSIOTHERAPY

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
1	261QP2000X	Physical Therapy Clinic/Center
2	2251S0007X	Sports Physical Therapist

General Provider Information

NPI Number	:	1093494171
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOWBS PHYSIOTHERAPY

Provider Business Mailing Address
First Line	:	125 TALBOT AVE
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95404-4033
Country	:	US
Telephone Number	:	831-419-2572
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 TALBOT AVE
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95404-4033
Country	:	US
Telephone Number	:	831-419-2572
Fax Number	:

Authorized Official
Title or Position	:	OWNER/ PHYSICAL THERAPIST
Name	:	RYAN MOWBRAY
Credential	:	PT
Telephone Number	:	831-419-2572

Provider Enumeration Date	:	07/14/2023
Last Update Date	:	07/14/2023

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Directions to “MOWBS PHYSIOTHERAPY ” Practice Location

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