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NPI Code Detail

MEDICARE: MARK E TATE MPT

MEDICARE: MARK E TATE MPT
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
1225100000XPhysical TherapistPT27239CA

General Provider Information

NPI Number : 1952477705
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK E TATE MPT
Provider Business Mailing Address
First Line : 3639 MIDWAY DR STE B286
Second Line :
City : SAN DIEGO
State : CA
Zip : 92110-5254
Country : US
Telephone Number : 858-488-3597
Fax Number : 858-488-3178
Provider Business Practice Location Address
First Line : 3115 OCEAN FRONT WALK
Second Line :
City : SAN DIEGO
State : CA
Zip : 92109-8729
Country : US
Telephone Number : 858-488-3597
Fax Number : 858-488-3178
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/24/2006
Last Update Date : 07/08/2007

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Directions to “ MARK E TATE MPT” Practice Location

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