Provider Demographics
NPI:1972339570
Name:MOTIVITY PHYSICAL THERAPY AND PERFORMANCE PC
Entity type:Organization
Organization Name:MOTIVITY PHYSICAL THERAPY AND PERFORMANCE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:PETRY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:949-633-1057
Mailing Address - Street 1:511 S CEDROS AVE STE A
Mailing Address - Street 2:
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-2903
Mailing Address - Country:US
Mailing Address - Phone:858-252-3688
Mailing Address - Fax:858-259-3503
Practice Address - Street 1:511 S CEDROS AVE STE A
Practice Address - Street 2:
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-2903
Practice Address - Country:US
Practice Address - Phone:858-252-3688
Practice Address - Fax:858-259-3503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy