Healthcare Provider Details

I. General information

NPI: 1497135255
Provider Name (Legal Business Name): REPAIR PHYSICAL THERAPY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2015
Last Update Date: 03/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16561 BOLSA CHICA ST STE 107
HUNTINGTON BEACH CA
92649-3574
US

IV. Provider business mailing address

16561 BOLSA CHICA ST STE 107
HUNTINGTON BEACH CA
92649-3574
US

V. Phone/Fax

Practice location:
  • Phone: 714-377-4313
  • Fax: 714-377-4313
Mailing address:
  • Phone: 714-377-4313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberPT 38002
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT 38002
License Number StateCA

VIII. Authorized Official

Name: DR. CHAD STEPHEN BEAUCHAMP
Title or Position: DOCTOR OF PHYSICAL THERAPY/ OWNER
Credential: DPT
Phone: 310-721-1082