Healthcare Provider Details

I. General information

NPI: 1083424998
Provider Name (Legal Business Name): REO PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2025
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 ROCHESTER ST
COSTA MESA CA
92627-3009
US

IV. Provider business mailing address

1835 NEWPORT BLVD STEA109-622
COSTA MESA CA
92627
US

V. Phone/Fax

Practice location:
  • Phone: 949-312-1676
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: CHRIS SCOTT
Title or Position: CEO
Credential: PT, DPT
Phone: 213-247-1214