Healthcare Provider Details

I. General information

NPI: 1316342033
Provider Name (Legal Business Name): COURY & BUEHLER PHYSICAL THERAPY - LAKE FOREST, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2014
Last Update Date: 04/27/2023
Certification Date: 04/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24301 MUIRLANDS BLVD SUITE T
LAKE FOREST CA
92630-3627
US

IV. Provider business mailing address

24301 MUIRLANDS BLVD SUITE T
LAKE FOREST CA
92630-3627
US

V. Phone/Fax

Practice location:
  • Phone: 949-271-0012
  • Fax: 949-271-0013
Mailing address:
  • Phone: 949-271-0012
  • Fax: 949-271-0013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: TIA SAMONTE
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 714-988-8113