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NPI Code Detail

MEDICARE: ELIZABETH WADE MPT

MEDICARE: ELIZABETH WADE MPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistPT 27260CA

General Provider Information

NPI Number : 1639494701
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH WADE MPT
Provider Business Mailing Address
First Line : 29811 SANTA MARGARITA PKWY STE 600
Second Line :
City : RANCHO SANTA MARGARITA
State : CA
Zip : 92688-3617
Country : US
Telephone Number : 949-600-5437
Fax Number :
Provider Business Practice Location Address
First Line : 29811 SANTA MARGARITA PKWY STE 600
Second Line :
City : RANCHO SANTA MARGARITA
State : CA
Zip : 92688-3617
Country : US
Telephone Number : 949-600-5437
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/01/2010
Last Update Date : 12/04/2025

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