Healthcare Provider Details

I. General information

NPI: 1821556689
Provider Name (Legal Business Name): TOP TIER REHAB & PERFORMANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2019
Last Update Date: 03/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 TULARE DR
ALISO VIEJO CA
92656-8084
US

IV. Provider business mailing address

45 TULARE DR
ALISO VIEJO CA
92656-8084
US

V. Phone/Fax

Practice location:
  • Phone: 909-569-3903
  • Fax:
Mailing address:
  • Phone: 909-569-3903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DIANA YORAY WANG
Title or Position: PHYSICAL THERAPIST/ATHLETIC TRAINER
Credential: PT, DPT, ATC
Phone: 909-569-3903