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Organization
MISI PHYSICAL THERAPY, PC
Active
Organization
MISI PHYSICAL THERAPY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRETT WILLIAM BLOOM PT, DPT (CFO)
(310) 386-6788
Entity
Organization
Contact information
Practice address
555 N NASH ST, EL SEGUNDO, CA 90245-2818
(310) 386-6788
Mailing address
1084 N EL CAMINO REAL # B-351, ENCINITAS, CA 92024-1334
(310) 386-6788
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
26571
CA PHYSICAL THERAPY BOARD
CA
Enumeration date
01/31/2023
Last updated
05/31/2023
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