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Organization
MANUAL ORTHOPEDIC PHYSICAL THERAPY INC
Active
Organization
MANUAL ORTHOPEDIC PHYSICAL THERAPY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
YVETTE CLARK (A/R MANAGER)
(619) 656-5102
Entity
Organization
Contact information
Practice address
955 LANE AVE, 201, CHULA VISTA, CA 91914-4525
(619) 421-9521
(619) 421-9568
Mailing address
1055 TIERRA DEL REY, C, CHULA VISTA, CA 91910-7875
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT14452
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
W17066
MEDICARE GROUP NUMBER
CA
Enumeration date
04/06/2010
Last updated
04/07/2011
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