Healthcare Provider Details

I. General information

NPI: 1093773640
Provider Name (Legal Business Name): LAGUNA HILLS PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 05/12/2023
Certification Date: 05/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25431 CABOT RD STE 101
LAGUNA HILLS CA
92653-5526
US

IV. Provider business mailing address

25431 CABOT RD STE 101
LAGUNA HILLS CA
92653-5526
US

V. Phone/Fax

Practice location:
  • Phone: 949-830-6220
  • Fax: 949-830-6227
Mailing address:
  • Phone: 949-830-6220
  • Fax: 949-830-6227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT25877
License Number StateCA

VIII. Authorized Official

Name: MISS SUSAN PRATT
Title or Position: PHYSICAL THERAPIST OWNER
Credential: MPT
Phone: 949-830-6220