MEDICARE: MUV PHYSICAL THERAPY, INC.

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	2251X0800X	Orthopedic Physical Therapist	24156	CA

General Provider Information

NPI Number	:	1831564756
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MUV PHYSICAL THERAPY, INC.

Provider Business Mailing Address
First Line	:	5650 EL CAMINO REAL
Second Line	:	SUITE 120
City	:	CARLSBAD
State	:	CA
Zip	:	92008-7124
Country	:	US
Telephone Number	:	760-919-2688
Fax Number	:

Provider Business Practice Location Address
First Line	:	5650 EL CAMINO REAL
Second Line	:	SUITE 120
City	:	CARLSBAD
State	:	CA
Zip	:	92008-7124
Country	:	US
Telephone Number	:	760-919-2688
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MOLLIE FITZSIMMONS
Credential	:	P.T.
Telephone Number	:	714-222-0053

Provider Enumeration Date	:	12/03/2015
Last Update Date	:	12/03/2015

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