| NPI | 1922031731 |
|---|---|
| Former Legal Business Name | PROSPORT PHYSICAL THERAPY MVSJC, INC. |
| Entity Type | Organization |
| Authorized Contact | BOBBY ISMAIL President 209-353-1988 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2006-07-08 |
| Last Update Date | 2023-12-06 |