MEDICARE: CENTRA PEDIATRIC THERAPY

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	235Z00000X	Speech-Language Pathologist
2	2251P0200X	Pediatric Physical Therapist
3	225XF0002X	Feeding, Eating & Swallowing Occupational Therapist
4	225XP0200X	Pediatric Occupational Therapist

General Provider Information

NPI Number	:	1902177025
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRA PEDIATRIC THERAPY

Provider Business Mailing Address
First Line	:	3002 DOW AVE #114
Second Line	:
City	:	TUSTIN
State	:	CA
Zip	:	92780-7236
Country	:	US
Telephone Number	:	714-731-4668
Fax Number	:	714-464-4668

Provider Business Practice Location Address
First Line	:	3002 DOW AVE STE 114
Second Line	:
City	:	TUSTIN
State	:	CA
Zip	:	92780-7247
Country	:	US
Telephone Number	:	714-731-4668
Fax Number	:	714-464-4668

Authorized Official
Title or Position	:	OWNER/OCCUPATIONAL THERAPIST
Name	:	MR. WAYNE BRIAN CENTRA
Credential	:	OT
Telephone Number	:	714-731-4668

Provider Enumeration Date	:	01/20/2012
Last Update Date	:	10/22/2025

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Directions to “CENTRA PEDIATRIC THERAPY ” Practice Location

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