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Organization
PHYSICAL EDGE, INC.
Active
Organization
PHYSICAL EDGE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATHEW MOORE MPT (OWNER)
(530) 753-9011
Entity
Organization
Contact information
Practice address
1460 DREW AVENUE, SUITE 200, DAVIS, CA 95618
(530) 753-9011
Mailing address
1460 DREW AVENUE, SUITE 200, DAVIS, CA 95618
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
2251P0200X
Pediatric Physical Therapist
PT 16894
CA
225XH1200X
Hand Occupational Therapist
1528
CA
225XP0200X
Pediatric Occupational Therapist
OT 8402
CA
Other
Enumeration date
09/29/2006
Last updated
03/13/2009
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