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Organization
PHYSICAL EDGE, INC.
Active
Organization
PHYSICAL EDGE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MATHEW MOORE MPT (OWNER)
(530) 753-9011
Entity
Organization
Contact information
Practice address
1970 LAKE BLVD STE 4, DAVIS, CA 95616-5663
(530) 753-9011
(530) 753-9021
Mailing address
1970 LAKE BLVD STE 4, DAVIS, CA 95616-5663
(530) 753-9011
(530) 753-9021
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
22276
CA
225100000X
Physical Therapist
27732
CA
225100000X
Physical Therapist
30188
CA
225100000X
Physical Therapist
32377
CA
225100000X
Physical Therapist
6526
CA
225XH1200X
Hand Occupational Therapist
1528
CA
Other
Enumeration date
07/06/2006
Last updated
03/13/2009
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