Healthcare Provider Details

I. General information

NPI: 1093200222
Provider Name (Legal Business Name): EMPOWER PHYSICAL THERAPY & AQUATICS INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2018
Last Update Date: 09/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 CORPORATE DR STE 160
LADERA RANCH CA
92694-2136
US

IV. Provider business mailing address

777 CORPORATE DR STE 160
LADERA RANCH CA
92694-2136
US

V. Phone/Fax

Practice location:
  • Phone: 949-939-8198
  • Fax:
Mailing address:
  • Phone: 949-545-7007
  • Fax: 833-278-1933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: BOB HAMIDI
Title or Position: CEO
Credential:
Phone: 949-939-8198