Healthcare Provider Details

I. General information

NPI: 1164994810
Provider Name (Legal Business Name): PHYSRECOVERY PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2018
Last Update Date: 02/18/2020
Certification Date: 02/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SPECTRUM CENTER DR STE 900
IRVINE CA
92618-4974
US

IV. Provider business mailing address

100 SPECTRUM CENTER DR STE 900
IRVINE CA
92618-4974
US

V. Phone/Fax

Practice location:
  • Phone: 949-800-8471
  • Fax: 949-988-0287
Mailing address:
  • Phone: 949-800-8471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name: DR. NOEL SANTAYANA
Title or Position: SECRETARY
Credential: PT, DPT
Phone: 909-371-6083