1427132828 NPI number — MRS. KIRSTIN LEIGH MOTTE MPT MASTERS OF PHYSI

Table of content: MRS. KIRSTIN LEIGH MOTTE MPT MASTERS OF PHYSI (NPI 1427132828)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427132828 NPI number — MRS. KIRSTIN LEIGH MOTTE MPT MASTERS OF PHYSI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOTTE
Provider First Name:
KIRSTIN
Provider Middle Name:
LEIGH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MPT MASTERS OF PHYSI
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427132828
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
31105 RANCHO VIEJO RD
Provider Second Line Business Mailing Address:
#C5
Provider Business Mailing Address City Name:
SAN JUAN CAPISTRANO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92675
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-218-4141
Provider Business Mailing Address Fax Number:
949-218-4242

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
31105 RANCHO VIEJO RD
Provider Second Line Business Practice Location Address:
#C5
Provider Business Practice Location Address City Name:
SAN JUAN CAPISTRANO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92675
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-218-4141
Provider Business Practice Location Address Fax Number:
949-218-4242
Provider Enumeration Date:
10/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT23967 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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