Provider Demographics
NPI:1598724320
Name:MOHN, ALAN EDWARD (PT)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:EDWARD
Last Name:MOHN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 E GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-3313
Mailing Address - Country:US
Mailing Address - Phone:760-489-6083
Mailing Address - Fax:760-489-1193
Practice Address - Street 1:355 E GRAND AVE
Practice Address - Street 2:SUITE #4
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-3313
Practice Address - Country:US
Practice Address - Phone:760-489-6083
Practice Address - Fax:760-489-1193
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT25020225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT25020AMedicare ID - Type UnspecifiedMEDICARE