Healthcare Provider Details

I. General information

NPI: 1164899597
Provider Name (Legal Business Name): PETER DOOLEY IV DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2015
Last Update Date: 11/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2767 E IMPERIAL HWY
BREA CA
92821
US

IV. Provider business mailing address

9041 BESTEL AVE
GARDEN GROVE CA
92844-2230
US

V. Phone/Fax

Practice location:
  • Phone: 714-578-8720
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number43122
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: