Healthcare Provider Details

I. General information

NPI: 1679661904
Provider Name (Legal Business Name): JANICE L DOTTS RPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23232 PERALTA DR STE 113
LAGUNA HILLS CA
92653-1436
US

IV. Provider business mailing address

18421 SANTA YOLANDA CIR
FOUNTAIN VALLEY CA
92708-5635
US

V. Phone/Fax

Practice location:
  • Phone: 949-922-2776
  • Fax:
Mailing address:
  • Phone: 714-963-2292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5063
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: