Healthcare Provider Details

I. General information

NPI: 1699873661
Provider Name (Legal Business Name): TOTAL BODY REHABILITATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30301 GOLDEN LANTERN SUITE B PURE PILATES
LAGUNA NIGUEL CA
92677
US

IV. Provider business mailing address

30301 GOLDEN LANTERN SUITE B PURE PILATES TOTAL BODY REHAB
LAGUNA NIGUEL CA
92677
US

V. Phone/Fax

Practice location:
  • Phone: 949-249-2456
  • Fax: 949-249-2365
Mailing address:
  • Phone: 949-249-2456
  • Fax: 949-249-2365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number24777
License Number StateCA

VIII. Authorized Official

Name: MRS. AMY SLOSSON FISCHER
Title or Position: OWNER PHYSICAL THERAPIST
Credential: PT
Phone: 949-249-2456