MEDICARE: MR. GUNNAR TORSTEN MOSSBERG MOMT DPT FAOMPT

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	PT10910	CA

General Provider Information

NPI Number	:	1508812082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GUNNAR TORSTEN MOSSBERG MOMT DPT FAOMPT

Provider Business Mailing Address
First Line	:	9855 ERMA RD
Second Line	:	#106
City	:	SAN DIEGO
State	:	CA
Zip	:	92131-3001
Country	:	US
Telephone Number	:	858-549-7111
Fax Number	:	858-549-9240

Provider Business Practice Location Address
First Line	:	9855 ERMA RD
Second Line	:	#106
City	:	SAN DIEGO
State	:	CA
Zip	:	92131-3001
Country	:	US
Telephone Number	:	858-549-7111
Fax Number	:	858-549-9240

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

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	05/14/2010

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