Healthcare Provider Details
I. General information
NPI: 1427576503
Provider Name (Legal Business Name): IPA PHYSIO OC PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 09/08/2017
Last Update Date: 01/27/2022
Certification Date: 01/27/2022
Deactivation Date:
Reactivation Date:
III. Provider practice location address
9891 IRVINE CENTER DRIVE SUITE 110
IRVINE CA
92618
US
IV. Provider business mailing address
9891 IRVINE CENTER DR STE 110
IRVINE CA
92618-4318
US
V. Phone/Fax
- Phone: 949-232-1955
- Fax: 949-668-7822
- Phone: 805-259-8209
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 261QP2000X |
| Taxonomy | Physical Therapy Clinic/Center |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
PETER
RUMFORD
Title or Position: PARTNER/CLINIC DIRECTOR
Credential: DPT, FAAOMPT, FFMT,
Phone: 949-232-1955