Healthcare Provider Details

I. General information

NPI: 1881427516
Provider Name (Legal Business Name): CONNECT PHYSICAL THERAPY AND WELLNESS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2024
Last Update Date: 09/27/2024
Certification Date: 09/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6930 WARNER AVE STE 104
HUNTINGTON BEACH CA
92647-5316
US

IV. Provider business mailing address

2621 E JACARANDA AVE
ORANGE CA
92867-6224
US

V. Phone/Fax

Practice location:
  • Phone: 714-485-9887
  • Fax: 949-216-5980
Mailing address:
  • Phone: 714-485-9887
  • Fax: 949-216-5980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: KERRY PICKERING
Title or Position: OWNER
Credential:
Phone: 714-488-5397