MEDICARE: TOTAL MOTION SPORTS THERAPY

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669011177
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOTAL MOTION SPORTS THERAPY

Provider Business Mailing Address
First Line	:	8941 ATLANTA AVE # 355
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92646-7121
Country	:	US
Telephone Number	:	714-369-9328
Fax Number	:

Provider Business Practice Location Address
First Line	:	808 ADAMS AVE
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92648-3214
Country	:	US
Telephone Number	:	714-369-9328
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	JAKE GILBERT
Credential	:	PTA
Telephone Number	:	714-369-9328

Provider Enumeration Date	:	12/31/2019
Last Update Date	:	12/31/2019

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Directions to “TOTAL MOTION SPORTS THERAPY ” Practice Location

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