Healthcare Provider Details

I. General information

NPI: 1104541069
Provider Name (Legal Business Name): JASON LE TRAN PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2022
Last Update Date: 05/10/2023
Certification Date: 05/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3230 E. IMPERIAL HWY SUITE 100
BREA CA
92821-6735
US

IV. Provider business mailing address

3230 E. IMPERIAL HWY SUITE 100
BREA CA
92821-6735
US

V. Phone/Fax

Practice location:
  • Phone: 714-256-5074
  • Fax: 714-256-0770
Mailing address:
  • Phone: 714-988-8110
  • Fax: 714-988-8111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number302884
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: