Healthcare Provider Details

I. General information

NPI: 1316428048
Provider Name (Legal Business Name): ACCESS ORTHOPEDIC PHYSICAL THERAPY AND CONDITIONING INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2018
Last Update Date: 07/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

546 S BREA BLVD
BREA CA
92821-5304
US

IV. Provider business mailing address

546 S BREA BLVD
BREA CA
92821-5304
US

V. Phone/Fax

Practice location:
  • Phone: 714-257-5551
  • Fax: 562-320-5167
Mailing address:
  • Phone: 714-257-5551
  • Fax: 562-320-5167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number34285
License Number StateCA

VIII. Authorized Official

Name: TAE HO LEE
Title or Position: PHYSICAL THERAPIST
Credential: PHYSICAL THERAPIST
Phone: 714-257-5551