| NPI | 1811310170 |
|---|---|
| Doing Business As | LONGEVITY PHYSICAL THERAPY |
| Entity Type | Organization |
| Authorized Contact | BRETT BLOOM CFO, Owner 760-230-2316 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: CA 40858) |
| Enumeration Date | 2014-01-22 |
| Last Update Date | 2014-01-22 |