Individual
LISA BOURBEAU MUMFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
833 BROADWAY, SUITE 100, EL CAJON, CA 92021-4668
(619) 447-7774
Mailing address
6209 PEARL LAKE AVE, SAN DIEGO, CA 92119-3341
(619) 261-3177
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
PT 20702
CA
2251P0200X
Pediatric Physical Therapist
Primary
PT 20702
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT 20702
PHYSICAL THERAPY
CA
Enumeration date
02/16/2009
Last updated
02/16/2009
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