Healthcare Provider Details

I. General information

NPI: 1780565697
Provider Name (Legal Business Name): MARA FURNISH PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2025
Last Update Date: 09/09/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 S CHAPARRAL CT STE 160
ANAHEIM CA
92808-2283
US

IV. Provider business mailing address

114 LYDIA LN
CORONA CA
92882-8524
US

V. Phone/Fax

Practice location:
  • Phone: 714-794-5889
  • Fax:
Mailing address:
  • Phone: 951-317-1458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number308492
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: