Individual
MIKE JOHN MAYNARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
4655 RUFFNER ST, STE. 270, SAN DIEGO, CA 92111-2275
(800) 787-6787
Mailing address
32 POTOMAC, IRVINE, CA 92620-3254
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
3934
CA
Other
Enumeration date
03/20/2007
Last updated
07/08/2007
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