Healthcare Provider Details

I. General information

NPI: 1639713340
Provider Name (Legal Business Name): STAC PHYSICAL THERAPY LAGUNA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2019
Last Update Date: 03/28/2025
Certification Date: 03/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9563 LAGUNA SPRINGS DR
ELK GROVE CA
95758-8204
US

IV. Provider business mailing address

4432 FIR AVE
SEAL BEACH CA
90740-2906
US

V. Phone/Fax

Practice location:
  • Phone: 916-691-9822
  • Fax: 916-691-9448
Mailing address:
  • Phone: 714-904-2703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251H1200X
TaxonomyHand Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: OR NATIV
Title or Position: DIRECTOR/PRESIDENT
Credential:
Phone: 650-796-4048