Healthcare Provider Details

I. General information

NPI: 1194481119
Provider Name (Legal Business Name): NEW WORLD PERFORMANCE AND PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2021
Last Update Date: 11/14/2021
Certification Date: 11/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34556 VIA ESPINOZA # A
CAPISTRANO BEACH CA
92624-1317
US

IV. Provider business mailing address

34556 VIA ESPINOZA # A
CAPISTRANO BEACH CA
92624-1317
US

V. Phone/Fax

Practice location:
  • Phone: 949-485-8197
  • Fax:
Mailing address:
  • Phone: 949-485-8197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BRYAN WAYNE RUPKE
Title or Position: PRESIDENT/LEAD PHYSICAL THERAPIST
Credential: DPT
Phone: 949-485-8197