MEDICARE: RISING SUN PHYSICAL THERAPY & WELLNESS

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
1	261QP2000X	Physical Therapy Clinic/Center		CA

General Provider Information

NPI Number	:	1881003440
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RISING SUN PHYSICAL THERAPY & WELLNESS

Provider Business Mailing Address
First Line	:	20301 SW ACACIA ST STE 150
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-1741
Country	:	US
Telephone Number	:	949-274-9551
Fax Number	:	949-264-8219

Provider Business Practice Location Address
First Line	:	20301 SW ACACIA ST STE 150
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-1741
Country	:	US
Telephone Number	:	949-274-9551
Fax Number	:	949-264-8219

Authorized Official
Title or Position	:	CEO
Name	:	DR. NATSUKO WATANABE
Credential	:	DPT
Telephone Number	:	949-274-9551

Provider Enumeration Date	:	08/07/2014
Last Update Date	:	03/27/2020

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