Healthcare Provider Details

I. General information

NPI: 1285544148
Provider Name (Legal Business Name): RE-ACTIVE PHYSICAL THERAPY AND PERFORMANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 SAINT MORITZ ST
ALISO VIEJO CA
92656-1313
US

IV. Provider business mailing address

24 SAINT MORITZ ST
ALISO VIEJO CA
92656-1313
US

V. Phone/Fax

Practice location:
  • Phone: 909-565-3521
  • Fax:
Mailing address:
  • Phone: 909-565-3521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: STEVEN ANTHONY SAMANIEGO
Title or Position: OWNER
Credential: PT, DPT
Phone: 909-565-3521