MEDICARE: ROYAL TU 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
1	225100000X	Physical Therapist	299507	CA

General Provider Information

NPI Number	:	1396349197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROYAL TU PT

Provider Business Mailing Address
First Line	:	4501 MISSION BAY DR STE 3K
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-4926
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4501 MISSION BAY DR STE 3K
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-4926
Country	:	US
Telephone Number	:	877-472-2261
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/23/2020
Last Update Date	:	12/04/2025

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Directions to “ ROYAL TU PT” Practice Location

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