Healthcare Provider Details

I. General information

NPI: 1588026371
Provider Name (Legal Business Name): SHORE2SKY PHYSICAL THERAPY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 02/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5267 WARNER AVE # 195
HUNTINGTON BEACH CA
92649-4079
US

IV. Provider business mailing address

5267 WARNER AVE # 195
HUNTINGTON BEACH CA
92649-4079
US

V. Phone/Fax

Practice location:
  • Phone: 714-377-4311
  • Fax:
Mailing address:
  • Phone: 714-377-4311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number38002
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number38002
License Number StateCA

VIII. Authorized Official

Name: DR. CHAD STEPHEN BEAUCHAMP
Title or Position: OWNER
Credential: DPT
Phone: 714-377-4311