Basic Information
| Provider Information | |||||||||
| NPI: | 1134175169 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MC PHYSICAL THERAPY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2082 POINTE PKWY | ||||||||
| Address2: | |||||||||
| City: | SPRING VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919782018 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 2082 POINTE PKWY | ||||||||
| Address2: | |||||||||
| City: | SPRING VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919782018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6198386158 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | CAZALAS | ||||||||
| AuthorizedOfficialFirstName: | MICHELE | ||||||||
| AuthorizedOfficialMiddleName: | KATHERINE | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6198386158 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | PT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.