Provider Demographics
NPI:1083929111
Name:MVP SPORTS TECHNOLOGIES
Entity Type:Organization
Organization Name:MVP SPORTS TECHNOLOGIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:CUSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-215-8941
Mailing Address - Street 1:23602 VIA FABRICANTE
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-3143
Mailing Address - Country:US
Mailing Address - Phone:949-215-8941
Mailing Address - Fax:
Practice Address - Street 1:23602 VIA FABRICANTE
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-3143
Practice Address - Country:US
Practice Address - Phone:949-215-8941
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30062261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy